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Characteristics of diabetes after pediatric liver transplant

Authors


Nanda Kerkar, MD, Associate Professor of Pediatrics and Surgery, Division of Pediatric Hepatology and Recanati-Miller Transplant Institute, Mount Sinai School of Medicine, 1 Gustave Levy Place Box, 1104, New York, NY 10029, USA
Tel.: 212 659 8060
Fax: 212 241 2064
E-mail: nanda.kerkar@mountsinai.org

Abstract

Greig F, Rapaport R, Klein G, Akler G, Annunziato R, Miloh T, Arnon R, Florman S, Kerkar N. Characteristics of diabetes after pediatric liver transplant.

Abstract:  Studies of DALT in pediatric recipients describe incidence and risk factors, but diagnostic criteria varied. This study reports characteristics and course of pediatric DALT by established diabetes criteria. Retrospective chart review of pediatric LT recipients evaluated for hyperglycemia (1/1/1997–12/30/2009) and matched, non-diabetic controls. DALT: random blood glucose >11.1 mm, ≥2 times, with insulin treatment. DALT diagnosed in 8.0% (24/300) included 7/24 (29.2%) with severe hyperglycemia (>27.7 mm), ketoacidosis in 2/24 (8.3%). At diagnosis, age was ≥11 yr old in 22/24 (91.7%); body mass was lean (BMIz −0.2 ± 1.5). Mean blood glucose was 24.6 mm with negative diabetes autoantibodies (19/19) and elevated C-peptide (2.3 nm). DALT onset median 5.0 months included 29.1% >12 months. Insulin duration median 4.6 months included 41.7% >6 months. DALT resolved in 83.3% over 4.9 (0.9–9.1) yr. DALT differed from controls by increased preceding rejections, prednisolone dose, tacrolimus level, and triple immunosuppression (all p < 0.01). In conclusion, pediatric DALT occurred in non-obese adolescents with insulin resistance, distinct from diabetes types 1 or 2. DALT was associated with preceding rejection and increased immunosuppression. Blood glucose monitoring, especially during increased immunosuppression following LT, could allow early diagnosis and reduce morbidity.

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