3. EARLY POST-RENAL TRANSPLANT HYPERGLYCEMIA
Main Article Content
Abstract
Introduce: Renal transplantation is generally the preferred treatment of patients with end-stage renal. Kidney transplantation is currently the most promising form of renal replacement therapy. Kidney transplantation improves patient survival, quality of life, and cost-effectiveness when compared to dialysis. Hyperglycemia after kidney transplantation is common in both diabetic and non-diabetic patients. Both pretransplant and post-transplant diabetes mellitus are associated with increased kidney allograft failure and mortality. Glucose management may be challenging for kidney transplant recipients. Though post-transplant diabetes mellitus (occurring more than 45 days after transplantation) and its complications are well described, early post-renal transplant hyperglycemia (less than 45 days) similarly puts kidney transplant recipients at risk of infections, rehospitalizations, and graft failure and is not emphasized much in the literature.
Objective: The objective of the article is to address a common condition after kidney transplantation, which is early post-transplant hyperglycemia. It also analyzes the pathophysiology, related factors, complications, and the goals of glycemic management in this population.
Method: The meta-analysis research method includes articles searched on electronic databases such as PubMed, Journals, and ScienceDirect, covering diabetes, post-transplant hyperglycemia, kidney transplantation, the relationship between pancreatic beta cells and fasting blood glucose, the pathophysiology of hyperglycemia, and some articles related to anti-rejection drug treatments. Early postoperative hyperglycemia after kidney transplantation is associated with complications such as acute rejection, rehospitalization, cardiovascular diseases, infections, and post-transplant diabetes
Conclusion: Early postoperative hyperglycemia occurring within 45 days after kidney transplantation increases the risk of rehospitalization for recipients due to infections such as CMV, acute rejection within 20 days post-transplant, cardiovascular events, and post-transplant diabetes. Both patients with and without a history of pre-transplant diabetes can experience early postoperative hyperglycemia.
Identifying risk factors such as high pre-transplant blood glucose levels, pre-transplant diabetes, glucocorticoid use, stress, postoperative pain, pre-existing chronic infections like chronic hepatitis C or CMV, and post-transplant infections is crucial for early postoperative hyperglycemia after kidney transplantation.
Insulin is currently the standard treatment; however, other new drugs such as GLP-1 RA and SGLT-2 may also be effective, but further research is needed.
Article Details
Keywords
Early hyperglycemia, diabetes, kidney transplant surgery
References
[2] Sharif A, Hecking M, de Vries AP et al, Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions, Am J Transplant, 2014, 14(9): 1992-2000.
[3] Chakkera HA, Weil EJ, Castro J et al, Hyperglycemia during the immediate period after kidney transplantation, Clin J Am Soc Nephrol, 2009, 4(4): 853-859.
[4] Dzúrik R, Spustová V, Lajdová I, Inhibition of glucose utilization in isolated rat soleus muscle by pseudouridine: implications for renal failure, Nephron, 1993, 65(1): 108-110.
[5] Mathew JT, Rao M, Job V, Ratnaswamy S, Jacob CK, Post-transplant hyperglycaemia: a study of risk factors, Nephrol Dial Transplant, 2003,
18(1), 164-171.
[6] Cosio FG, Kudva Y, van der Velde M et al, New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation, Kidney Int.
[7] Sheu A, Depczynski B, O’Sullivan AJ, Luxton G, Mangos G, The effect of different glycaemic states on renal transplant outcomes, J Diabetes
Res., 2016, 2016: 8735782.
[8] Ritzel RA, Butler AE, Rizza RA, Veldhuis JD, Butler PC, Relationship between beta-cell mass and fasting blood glucose concentration in humans, Diabetes Care, 2006, 29(3): 717-718.
[9] Rickels MR, Mueller R, Teff KL, Naji A, {beta}- Cell secretory capacity and demand in recipients of islet, pancreas, and kidney transplants, J Clin Endocrinol Metab, 2010, 95(3): 1238-1246.
[10] Masson P, Henderson L, Chapman JR, Craig JC, Webster AC, Belatacept for kidney transplant recipients, Cochrane Database Syst Rev., 2014, 11.
[11] COVID-19 Treatment Guidelines Panel. Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. Accessed August 8, 2021.
[12] Wojtusciszyn A, Mourad G, Bringer J, Renard E, Continuous glucose monitoring after kidney transplantation in non-diabetic patients: early hyperglycaemia is frequent and may herald post-transplantation diabetes mellitus and graft failure, Diabetes Metab, 2013, 39(5): 404-410.
[13] Panés J, Kurose I, Rodriguez-Vaca D et al, Diabetes exacerbates inflammatory responses to ischemia-reperfusion, Circulation, 1996, 93(1): 161-167.
[14] Pistrosch F, Natali A, Hanefeld M, Is hyperglycemia a cardiovascular risk factor? Diabetes Care, 2011, 34(Suppl 2): S128-S131.
[15] Kukla A, Hill J, Merzkani M et al, The use of GLP1R agonists for the treatment of type 2 diabetes in kidney transplant recipients, Transplant
Direct, 2020, 6(2): e524.
[16] Shah M, Virani Z, Rajput P, Shah B, Efficacy and safety of canagliflozin in kidney transplant patients, Indian J Nephrol, 2019, 29(4): 278-281.
[17] Aniral Iqbal, Keren Zhou, Sangeeta R Kashyap, M Cecilia Langsan, Early post-renal transplant hyper glycemia, The Journal of Clinical Endocrinology & Metabolism, 2022, Pages 549-562.