Cargando…
Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients
Diabetes is common in patients waitlisted for liver transplantation because of end-stage liver disease or hepatocellular cancer as well as in posttransplant phase (posttransplantation diabetes mellitus). In both conditions, the presence of diabetes severely affects disease burden and long-term clini...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904447/ https://www.ncbi.nlm.nih.gov/pubmed/34172646 http://dx.doi.org/10.1097/TP.0000000000003867 |
_version_ | 1784883615517114368 |
---|---|
author | Brodosi, Lucia Petta, Salvatore Petroni, Maria L. Marchesini, Giulio Morelli, Maria C. |
author_facet | Brodosi, Lucia Petta, Salvatore Petroni, Maria L. Marchesini, Giulio Morelli, Maria C. |
author_sort | Brodosi, Lucia |
collection | PubMed |
description | Diabetes is common in patients waitlisted for liver transplantation because of end-stage liver disease or hepatocellular cancer as well as in posttransplant phase (posttransplantation diabetes mellitus). In both conditions, the presence of diabetes severely affects disease burden and long-term clinical outcomes; careful monitoring and appropriate treatment are pivotal to reduce cardiovascular events and graft and recipients’ death. We thoroughly reviewed the epidemiology of diabetes in the transplant setting and the different therapeutic options, from lifestyle intervention to antidiabetic drug use—including the most recent drug classes available—and to the inclusion of bariatric surgery in the treatment cascade. In waitlisted patients, the old paradigm that insulin should be the treatment of choice in the presence of severe liver dysfunction is no longer valid; novel antidiabetic agents may provide adequate glucose control without the risk of hypoglycemia, also offering cardiovascular protection. The same evidence applies to the posttransplant phase, where oral or injectable noninsulin agents should be considered to treat patients to target, limiting the impact of disease on daily living, without interaction with immunosuppressive regimens. The increasing prevalence of liver disease of metabolic origin (nonalcoholic fatty liver) among liver transplant candidates, also having a higher risk of noncirrhotic hepatocellular cancer, is likely to accelerate the acceptance of new drugs and invasive procedures, as suggested by international guidelines. Intensive lifestyle intervention programs remain however mandatory, both before and after transplantation. Achievement of adequate control is mandatory to increase candidacy, to prevent delisting, and to improve long-term outcomes. |
format | Online Article Text |
id | pubmed-9904447 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-99044472023-02-14 Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients Brodosi, Lucia Petta, Salvatore Petroni, Maria L. Marchesini, Giulio Morelli, Maria C. Transplantation Reviews Diabetes is common in patients waitlisted for liver transplantation because of end-stage liver disease or hepatocellular cancer as well as in posttransplant phase (posttransplantation diabetes mellitus). In both conditions, the presence of diabetes severely affects disease burden and long-term clinical outcomes; careful monitoring and appropriate treatment are pivotal to reduce cardiovascular events and graft and recipients’ death. We thoroughly reviewed the epidemiology of diabetes in the transplant setting and the different therapeutic options, from lifestyle intervention to antidiabetic drug use—including the most recent drug classes available—and to the inclusion of bariatric surgery in the treatment cascade. In waitlisted patients, the old paradigm that insulin should be the treatment of choice in the presence of severe liver dysfunction is no longer valid; novel antidiabetic agents may provide adequate glucose control without the risk of hypoglycemia, also offering cardiovascular protection. The same evidence applies to the posttransplant phase, where oral or injectable noninsulin agents should be considered to treat patients to target, limiting the impact of disease on daily living, without interaction with immunosuppressive regimens. The increasing prevalence of liver disease of metabolic origin (nonalcoholic fatty liver) among liver transplant candidates, also having a higher risk of noncirrhotic hepatocellular cancer, is likely to accelerate the acceptance of new drugs and invasive procedures, as suggested by international guidelines. Intensive lifestyle intervention programs remain however mandatory, both before and after transplantation. Achievement of adequate control is mandatory to increase candidacy, to prevent delisting, and to improve long-term outcomes. Lippincott Williams & Wilkins 2021-06-23 2022-03 /pmc/articles/PMC9904447/ /pubmed/34172646 http://dx.doi.org/10.1097/TP.0000000000003867 Text en Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Reviews Brodosi, Lucia Petta, Salvatore Petroni, Maria L. Marchesini, Giulio Morelli, Maria C. Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients |
title | Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients |
title_full | Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients |
title_fullStr | Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients |
title_full_unstemmed | Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients |
title_short | Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients |
title_sort | management of diabetes in candidates for liver transplantation and in transplant recipients |
topic | Reviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904447/ https://www.ncbi.nlm.nih.gov/pubmed/34172646 http://dx.doi.org/10.1097/TP.0000000000003867 |
work_keys_str_mv | AT brodosilucia managementofdiabetesincandidatesforlivertransplantationandintransplantrecipients AT pettasalvatore managementofdiabetesincandidatesforlivertransplantationandintransplantrecipients AT petronimarial managementofdiabetesincandidatesforlivertransplantationandintransplantrecipients AT marchesinigiulio managementofdiabetesincandidatesforlivertransplantationandintransplantrecipients AT morellimariac managementofdiabetesincandidatesforlivertransplantationandintransplantrecipients |