Endocrine Abstracts

Aim

Analyze a number of foreign sources to assess the risks of developing post-transplant diabetes mellitus (PTSD).

Materials and methods

In total, we analyzed more than 70 sources from Western Europe, East Asia and South Africa. Pancreatic β-cell dysfunction, impaired insulin secretion associated with the use of calcineurin inhibitors and inhibitors of the mammalian target of rapamycin complex 1 (mTORC1), postoperative weight gain, and hepatitis C associated with insulin resistance. According to Lv C., Zhang Y and all; Song J.L., Gao W and all; Xue M., Lv C. and all - a quarter of patients without diabetes mellitus developed PTSD at the time of liver transplantation, which corresponded to the previously presented data - from 19 to 35% However, studies by Liu F.C., Lin J.R. and all; Abe T., Onoe T and all reported lower incidence rates of 6 to 8%. According to Aravinthan A.D., Fateen W., Doyle A.C. et al., the incidence of PTDM was significantly higher in the early post-transplant period. According to the results of a retrospective study by E.J. Carey et al., A 2-fold increase in the risk of developing PTSD is associated with an excess of plasma glucose for every 10 mg/dl before liver transplantation. It has been suggested that a wide range of factors in the recipient and donor, the causes and severity of liver disease, as well as the characteristics and duration of surgery and treatment in the post-transplant period play an important role in the development of PTSD. A meta-analysis of 19 retrospective studies of over 4.500 patients by D.W. Li et al., Identified independent risk factors for PTSD. These included male sex, body mass index, etiology of hepatitis C, impaired fasting plasma glucose levels before liver transplantation, and tacrolimus use.

Conclusions

General approaches to the treatment of PTSD have not yet been developed. Patients require individual drug correction under the supervision of an endocrinologist and hepatologist. Of course, it will be more difficult for liver cells burdened with pathologically altered metabolism in diabetes mellitus to cope with toxic effects, because this organ is characterized by a reduced functional reserve. Therefore, when prescribing therapy, preference should be given to drugs that are least metabolized in the liver. In patients with diabetes after liver transplantation, it is necessary to carry out not only adequate immunosuppressive therapy, but also hypoglycemic therapy. Insulin is currently the drug of choice.