Artificial pancreas stabilizes glucose levels during liver transplantation
An artificial endocrine pancreas can successfully control and stabilize perioperative glucose levels during liver transplantation without inducing hypoglycaemia, according to a recent study. Therefore, such devices may be useful in cutting the risk of postoperative infections.
Fourteen patients (median age 59 years; eight females) who underwent live donor liver transplantation (LDLT) were given an artificial pancreas device to facilitate intraoperative glucose control. Using the chi-square and Mann-Whitney U tests, researchers compared their perioperative glycaemic control and incidence of postoperative infections to a control group, in whom the sliding scale method was instead employed (n=14; median age 58 years; four females).
There were no significant differences in the minimum (92.5 vs 91 mg/dL) and maximum (172.5 vs 160 mg/dL) intraoperative blood glucose concentrations between the control and artificial endocrine pancreas groups. [Artif Organs 2018;doi:10.1111/aor.13373]
In contrast, the average blood glucose level was significantly lower in the artificial pancreas vs control patients (118 vs 141 mg/dL; p<0.01). Regardless, no cases of extreme hypoglycaemia (<40 mg/dL) were reported in either group.
Moreover, the amount of insulin (73.0 vs 0 U) and additional glucose (12.6 vs 0 g; p<0.001 for both) delivered intraoperatively were significantly higher in the artificial pancreas group.
“The glucose trends observed in the present study were similar to those of previous reports: the blood glucose level became elevated in the neohepatic phase, both with and without an artificial endocrine pancreas. However, the patients who were treated with an artificial endocrine pancreas showed less fluctuation in their blood glucose levels,” researchers noted.
In terms of postoperative infections, the incidence rate of early post-transplant bacterial infections was significantly lower in the artificial endocrine pancreas vs sliding scale control groups (35.7 percent vs 78.6 percent; p=0.03). This effect was primarily driven by the comparative difference in pneumonia incidence rates (7.1 percent vs 50.0 percent; p=0.02).
No such between-group differences were observed for other infections such as bacteraemia (artificial pancreas vs control: 7.1 percent vs 21.4 percent), urinary tract infection (0 percent vs 7.1 percent), cholangitis (0 vs 7.1 percent) and early post-transplant sepsis (21.4 percent vs 35.7 percent).
In a comparative analysis of perioperative factors, researchers found that the use of artificial endocrine pancreas (p=0.05) and ABO incompatibility (p=0.10) were the only factors potentially predictive of post-transplant infections. Multiple regression analysis confirmed that only the former (odds ratio, 10.7; 95 percent CI, 1.5–78.4; p=0.01) was significant.
“This is the first report to show the clinical efficacy of an artificial endocrine pancreas device, in terms of the relationship between [intensive insulin therapy] and postoperative infection, in patients undergoing living donor liver transplantation,” said researchers.
Though it was not explicitly explored in the present study, researchers also believe that use of the artificial pancreas results in lower hospital costs. This is due to the drop in rates of postoperative infections, which in turns leads to a shorter length of hospital stay. [Wold J Gastroenterol 2018;15:4116-4121]
For future directions, “[t]he optimal blood sugar target range and the duration for which intensive insulin therapy should be administered using an artificial endocrine pancreas should be clarified in randomized control studies,” as well as the impact of blood glucose variability on postoperative outcomes, researchers added.