Mechanisms of postprandial hyperglycemia in liver transplant recipients: comparison of liver transplant patients with kidney transplant patients and healthy controls.

Details

Serval ID
serval:BIB_17737
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Mechanisms of postprandial hyperglycemia in liver transplant recipients: comparison of liver transplant patients with kidney transplant patients and healthy controls.
Journal
Diabetes and Metabolism
Author(s)
Schneiter P., Gillet M., Chioléro R., Jéquier E., Mosimann F., Temler E., Téta D., Matter M., Wauters J.P., Tappy L.
ISSN
1262-3636 (Print)
ISSN-L
1262-3636
Publication state
Published
Issued date
2000
Volume
26
Number
1
Pages
51-56
Language
english
Abstract
Impaired glucose tolerance or diabetes mellitus are frequent complications after organ transplantation, and are usually attributed to glucocorticoid and immunosuppressive treatments. Liver transplantation results in total hepatic denervation which may also affect glucoregulation. We therefore evaluated postprandial glucose metabolism in a group of patients with liver cirrhosis before and after orthotopic liver transplantation. Seven patients with liver cirrhosis of various etiologies, 6 patients having received a kidney transplant, and 6 healthy subjects were studied. Their glucose metabolism was evaluated in the basal state and over 4 hours after ingestion of a glucose load with 6.6 (2) H glucose dilution analysis. The patients with liver cirrhosis were studied before, and again 4 weeks (range 2-6) and 38 weeks (range 20-76, n=6) after orthotopic liver transplantation. Basal glucose metabolism was similar in liver and kidney transplant recipients. Impaired glucose tolerance was present in both groups, but postprandial hyperglycemia was exaggerated and lasted longer in liver transplant patients. Postprandial insulinemia was lower in liver transplant recipients, while C-peptide concentrations were comparable to those of kidney transplant recipients, indicating increased insulin clearance. Glucose turnover was not altered in both groups of patients during the initial 3 hours after glucose ingestion, but was higher in liver transplant early after transplantation during the fourth hour. Postprandial hyperglycemia remained unchanged in liver transplant recipients 38 weeks after liver transplantation, despite substantial reduction of immunosuppressive and glucocorticoid doses. We conclude that liver transplant recipients have severe postprandial hyperglycemia which can be attributed to insulinopenia (secondary, at least in part, to increased insulin clearance) and a late increased glucose turnover. These changes may be secondary to hepatic denervation.
Keywords
Adult, Blood Glucose/metabolism, Female, Humans, Hyperglycemia, Immunosuppressive Agents/therapeutic use, Kidney Transplantation/immunology, Kidney Transplantation/physiology, Liver Cirrhosis/blood, Liver Cirrhosis/surgery, Liver Transplantation/immunology, Liver Transplantation/physiology, Male, Middle Aged, Postprandial Period/physiology, Reference Values, Time Factors
Pubmed
Web of science
Create date
19/11/2007 12:11
Last modification date
20/08/2019 12:47
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