Effect of moderately intense perioperative glucose control on renal allograft function: a pilot randomized controlled trial in renal transplantation.
Parekh J, Roll GR, et al.Clinical Transplantation 2016; 30(10): 1242-1249.
Aims
To determine whether moderately intense glucose control during allograft reperfusion would reduce the incidence of poor graft function in kidney transplant recipients.
Interventions
Participants were randomized to receive either standard glucose control, or moderately intense glucose control.
Participants
60 adult patients with a diagnosis of diabetes mellitus scheduled for deceased donor renal transplantation.
Outcomes
The primary outcomes measured were poor graft function and the number of severe hypoglycemic events (blood glucose<40 mg/dL). Secondary outcomes measured were delayed graft function, perioperative death, stroke, seizure, serum creatinine, estimated glomerular filtration rate, biopsy-proven rejection and graft loss.
Follow-up
Average of 1.16 years
CET Conclusions
This interesting study from UCSF investigates the role of perioperative glucose control on outcomes following renal transplantation in diabetic patients. Patients were randomised to either moderately intensive glucose controls (80-160 mg/dl) or standard care for the first 24 hours after transplantation. The authors report a lower incidence of poor graft function (43.3% vs. 73.3%) with moderately intensive control, and no difference in safety outcomes or hypoglycaemia. Renal function was improved in the study group at 30 days (probably reflecting the improvement in poor function), with no differences seen by one year. The results presented suggest that improving perioperative glucose control may improve early outcomes after transplantation. There are some caveats. The incidence of poor and delayed graft function seen are very high, especially in the control group. This may reflect some selection and performance bias, especially given that the study is open label and the proportion of potentially eligible patients recruited to the study is low. When a stricter definition of DGF is used, the difference is smaller and does not reach significance. However, the results seen are supported by previous clinical and animal studies, and certainly warrant further investigation in a larger and more heterogeneous population.
Data analysis
Strict intention-to-treat analysis
Trial registration
Clinicaltrials.gov - NCT01643382