Peri-Liver Transplant Hyperglycemia: Mechanisms, Associated Factors, Consequences, and Management – A Systematic Review

Abstract

Introduction

Liver transplantation is associated with various metabolic disorders. Peri-transplant hyperglycemia is among the most frequent metabolic disorders among liver transplant recipients. Hyperglycemia following liver transplantation can increase the risk of post-transplant complications, potentially impacting both graft and recipient outcomes. Several studies have compared intensive with standard blood glucose control strategies in liver transplant recipients. However, a comprehensive protocol for managing peri-transplant hyperglycemia remains elusive. This review aimed to synthesise existing literature on the mechanisms, associated factors, and consequences of hyperglycemia after liver transplantation, and to provide recommendations for managing hyperglycemia in this patient population.

Method

PubMed, Scopus, and UpToDate databases and American Diabetes Association guidelines were searched without time limitations until February 2025.

Results

Peri-liver transplant hyperglycemia can be attributed to several factors, including post-reperfusion hepatocyte injury, insulin resistance stemming from underlying liver disease, surgical stress, and the use of immunosuppressive drugs. Various factors associated with peri-transplant hyperglycemia can be categorised into pre-transplant recipient factors, intraoperative factors, and donor-related factors. Research has shown that inadequate glycemic control during the peri-transplant period may have detrimental effects on post-transplant outcomes, including an increased incidence of infections, graft rejection, acute kidney injury, prolonged hospital stays, and higher overall mortality.

Conclusion

The suggestions presented in this article, which consider the recipient's medical history and clinical conditions, can serve as a framework for healthcare providers to manage peri-liver transplant hyperglycemia effectively.