Correlation of Pretransplant Glucose Metabolism and Nonalcoholic Fatty Liver Disease with the Development of Post Transplantation Diabetes Mellitus

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Abstract

Introduction

Post transplant diabetes mellitus (PTDM) is a strong independent predictor of mortality. Metabolic syndrome is known risk factor for diabetes and non alcoholic fatty liver disease(NAFLD) is a liver manifestation of metabolic syndrome. The aim of study was to analyze influence of pretransplant glucose metabolism and NAFLD on PTDM and to see any change in pattern of fatty liver post transplant.

Materials and Methods

Fifty chronic kidney disease, end stage renal disease(CKD-ESRD) patients who underwent renal transplantation were enrolled in study. Demographic data were collected; anthropometric variables were measured. Measurements of plasma glucose in the fasting state and 2 hours after ingestion of 75 g glucose, fasting insulin, c-peptide, beta cell function and insulin resistance were done within1 week before transplant and followed in post transplant period at 1,3 and 6 months.HOMA model was used to define beta cell function and insulin resistance.

Materials and Methods

Insulin resistance (IR) = (FI x G) /22.5 Beta cell function (B) = (20 x FI) / (G -3.5) Insulin sensitivity (IS) = 100/ IR; FI=fasting insulin (μIU/ml), and G=fasting glucose (mmol/l)

Materials and Methods

HbA1c, UGS abdomen and fibroscan were done pretransplant and repeated at 3, 6 months post transplant. Diabetes was defined according to ADA criteria.

Results

PTDM developed in 17(34%) patients. Mean age was 32.26 + 9.51 years. 2 hr plasma glucose was found to be higher in group that developed PTDM (123.18±8.15vs 97.30±1.72, p=0.010). HbA1c, FBS, fasting insulin, c peptide, insulin resistance and beta cell function were found to be non significantly higher in the group that later developed PTDM. Anthropometric variables, gender, basic disease, dialysis duration, NAFLD had no bearing on development of PTDM. No significant change was seen in pattern of fatty liver post transplant.

Discussion

The incidence of PTDM in our study was 34%(17/50 patients) which is comparable to study by Vincenti et al, who reported 30% incidence of PTDM(1).The mean duration of development of PTDM in our study was 30 days post transplant. In our study,2hr plasma glucose predicted development of diabetes in post transplant period which is similar to findings of a study done by Rao M et al(2).

Conclusion

PPBS is more sensitive parameter then FBS in predicting PTDM. Anthropometric measures and NAFLD are not predictive of PTDM in our group of patients where malnutrition acts as a confounder.

Conclusion

References:

Conclusion

1. Vincenti F, Friman S, Scheuermann E et al. Result of an international, randomized trial comparingglucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transplant 2007;7:1506-14.

Conclusion

2. Rao M, Jacob CK, Shastry JCM. Post-renal transplant diabetes mellitus-Aretrospective study. Nephrol. Dial. Transplant 1992;7:1039–1042.

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