Cargando…

Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment

Post-liver transplantation diabetes mellitus (PLTDM) develops in up to 30% of liver transplant recipients and is associated with increased risk of mortality and multiple morbid outcomes. PLTDM is a multicausal disorder, but the main risk factor is the use of immunosuppressive agents of the calcineur...

Descripción completa

Detalles Bibliográficos
Autores principales: Peláez-Jaramillo, Maria J., Cárdenas-Mojica, Allison A., Gaete, Paula V., Mendivil, Carlos O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104273/
https://www.ncbi.nlm.nih.gov/pubmed/29411291
http://dx.doi.org/10.1007/s13300-018-0374-8
_version_ 1783349456405528576
author Peláez-Jaramillo, Maria J.
Cárdenas-Mojica, Allison A.
Gaete, Paula V.
Mendivil, Carlos O.
author_facet Peláez-Jaramillo, Maria J.
Cárdenas-Mojica, Allison A.
Gaete, Paula V.
Mendivil, Carlos O.
author_sort Peláez-Jaramillo, Maria J.
collection PubMed
description Post-liver transplantation diabetes mellitus (PLTDM) develops in up to 30% of liver transplant recipients and is associated with increased risk of mortality and multiple morbid outcomes. PLTDM is a multicausal disorder, but the main risk factor is the use of immunosuppressive agents of the calcineurin inhibitor (CNI) family (tacrolimus and cyclosporine). Additional factors, such as pre-transplant overweight, nonalcoholic steatohepatitis and hepatitis C virus infection, may further increase risk of developing PLTDM. A diagnosis of PLTDM should be established only after doses of CNI and steroids are stable and the post-operative stress has been overcome. The predominant defect induced by CNI is insulin secretory dysfunction. Plasma glucose control must start immediately after the transplant procedure in order to improve long-term results for both patient and transplant. Among the better known antidiabetics, metformin and DPP-4 inhibitors have a particularly benign profile in the PLTDM context and are the preferred oral agents for long-term management. Insulin therapy is also an effective approach that addresses the prevailing pathophysiological defect of the disorder. There is still insufficient evidence about the impact of newer families of antidiabetics (GLP-1 agonists, SGLT-2 inhibitors) on PLTDM. In this review, we summarize current knowledge on the epidemiology, pathogenesis, course of disease and medical management of PLTDM.
format Online
Article
Text
id pubmed-6104273
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Springer Healthcare
record_format MEDLINE/PubMed
spelling pubmed-61042732018-08-27 Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment Peláez-Jaramillo, Maria J. Cárdenas-Mojica, Allison A. Gaete, Paula V. Mendivil, Carlos O. Diabetes Ther Review Post-liver transplantation diabetes mellitus (PLTDM) develops in up to 30% of liver transplant recipients and is associated with increased risk of mortality and multiple morbid outcomes. PLTDM is a multicausal disorder, but the main risk factor is the use of immunosuppressive agents of the calcineurin inhibitor (CNI) family (tacrolimus and cyclosporine). Additional factors, such as pre-transplant overweight, nonalcoholic steatohepatitis and hepatitis C virus infection, may further increase risk of developing PLTDM. A diagnosis of PLTDM should be established only after doses of CNI and steroids are stable and the post-operative stress has been overcome. The predominant defect induced by CNI is insulin secretory dysfunction. Plasma glucose control must start immediately after the transplant procedure in order to improve long-term results for both patient and transplant. Among the better known antidiabetics, metformin and DPP-4 inhibitors have a particularly benign profile in the PLTDM context and are the preferred oral agents for long-term management. Insulin therapy is also an effective approach that addresses the prevailing pathophysiological defect of the disorder. There is still insufficient evidence about the impact of newer families of antidiabetics (GLP-1 agonists, SGLT-2 inhibitors) on PLTDM. In this review, we summarize current knowledge on the epidemiology, pathogenesis, course of disease and medical management of PLTDM. Springer Healthcare 2018-02-06 2018-04 /pmc/articles/PMC6104273/ /pubmed/29411291 http://dx.doi.org/10.1007/s13300-018-0374-8 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Review
Peláez-Jaramillo, Maria J.
Cárdenas-Mojica, Allison A.
Gaete, Paula V.
Mendivil, Carlos O.
Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment
title Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment
title_full Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment
title_fullStr Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment
title_full_unstemmed Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment
title_short Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment
title_sort post-liver transplantation diabetes mellitus: a review of relevance and approach to treatment
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104273/
https://www.ncbi.nlm.nih.gov/pubmed/29411291
http://dx.doi.org/10.1007/s13300-018-0374-8
work_keys_str_mv AT pelaezjaramillomariaj postlivertransplantationdiabetesmellitusareviewofrelevanceandapproachtotreatment
AT cardenasmojicaallisona postlivertransplantationdiabetesmellitusareviewofrelevanceandapproachtotreatment
AT gaetepaulav postlivertransplantationdiabetesmellitusareviewofrelevanceandapproachtotreatment
AT mendivilcarloso postlivertransplantationdiabetesmellitusareviewofrelevanceandapproachtotreatment