Impact of Glycemic Control After Reperfusion on Acute Kidney Injury in Living Donor Liver Transplantation

NCT ID: NCT06320730

Last Updated: 2024-03-20

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 3790 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2020-08-25
• Study Completion Date: 2021-03-01

Brief Summary

This retrospective cohort study of patients classified by the blood glucose level after reperfusion in liver transplantation repicient. Our object is to investigate whether controlling BG levels within the optimal range during neohepatic phase is associated with a reduction of AKI incidence. Furthermore, severe AKI, chronic kidney disease (CKD), major adverse cardiac event (MACE) and mortality were also investigated.

Detailed Description

The detrimental impact of glucose instability including hyper- and hypoglycemia on postoperative outcomes has been well-established in various fields, particularly in cardiac surgery, and intensive care unit settings. Also, glucose instability occurs frequently in liver transplantation (LT) surgery, attributed to factors such as insulin resistance, surgical stress, and onset of gluconeogenesis after reperfusion of the newly transplanted graft. Previous reports have demonstrated that hyperglycemia is associated with increased mortality, a higher incidence of graft rejection, and surgical site infection in LT. Alongside hyperglycemia, it is also important to consider hypoglycemia, given its association with adverse outcomes.

Acute kidney injury (AKI) stands as one of the most common and critical complications following LT, impacting extended duration of hospital stay, increased morbidity, and mortality. Although the etiology of AKI after LT is multifactorial, perioperative hyper- and hypoglycemia have also been suggested as potential risk factors for postoperative AKI. However, a recent study only has demonstrated that increased glucose variability, rather than hyper-and hypoglycemia alone, is associated with postoperative AKI after LT. The contradictory results observed to date may be attributed to differences in the definition of hyperglycemia, reflecting the challenges in determining the optimal blood glucose (BG) level in LT. In our study, the optimal BG level was determined according to the most recently updated and professional guidelines on glycemic control.

Identifying the timing for glycemic control during LT is also as crucial as determining the optimal BG level. BG levels reach their peak in the neohepatic phase and begin to decrease 3 hours after reperfusion. This excessively elevated hyperglycemia is due to glucose influx from the grafted liver, in addition to peripheral insulin resistance, and gradually decreases after successful LT. Therefore, maintaining a well-controlled BG level within the optimal range, especially during the neohepatic phase, may be associated with better outcomes after transplantation.

Our object is to investigate whether controlling BG levels within the optimal range during neohepatic phase is associated with a reduction of AKI incidence. Furthermore, severe AKI, chronic kidney disease (CKD), major adverse cardiac event (MACE), and mortality were also investigated.

Conditions

Acute Kidney Injury; Hyperglycemia; Hypoglycemia; End Stage Liver Disease

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: RETROSPECTIVE

Study Groups

Group 110 < REP BG < 180

Those with blood glucose levels over 110 and under 180 after reperfusion in liver transplantation recipients.

Observational study, records of blood glucose level after reperfusion

Intervention Type: OTHER

Analyzes blood glucose level after reperfusion by dividing it into two groups: those with blood glucose levels between 110 and 180 and those with blood glucose levels below 110 or above 180.

Group REP BG ≤110 or ≥180

Those with blood glucose levels below 110 or above 180 after reperfusion in liver transplantation recipients.

No interventions assigned to this group

Interventions

Observational study, records of blood glucose level after reperfusion

Analyzes blood glucose level after reperfusion by dividing it into two groups: those with blood glucose levels between 110 and 180 and those with blood glucose levels below 110 or above 180.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Living donor liver transplantation recipients

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Asan Medical Center

OTHER

Sponsor Role: lead

Responsible Party

Jun-Gol Song

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Jun-Gol Song

Seoul, Song-pa Gu, South Korea

Countries

South Korea

Other Identifiers

2020-0675

Identifier Type: -

Identifier Source: org_study_id