Characteristics of diabetes after pediatric liver transplant

Fenella Greig, Robert Rapaport, Genna Klein, Gidon Akler, Rachel Annunziato, Tamir Miloh, Ronen Arnon, Sander Florman, Nanda Kerkar

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)27-33
Number of pages7
JournalPediatric Transplantation
Volume17
Issue number1
DOIs
StatePublished - Feb 2013
Externally publishedYes

Keywords

  • adolescents
  • diagnostic criteria
  • hyperglycemia
  • non-obese
  • transplantation immunosuppression

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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