182] FASTING GLUCOSE IS NOT USEFUL FOR DETERMINATION OF IMPAIRED GLUCOSE TOLERANCE IN LIVING-DONOR LIVER TRANSPLANTATION

Abstract

Introduction: Studies investigating impaired glucose tolerance or diabetes mellitus (DM) in transplantation mostly use fasting glucose for determination of DM. We prospectively analyzed the impact of fasting glucose in comparison to advanced methods in recipients and donors of livingdonor liver transplants (LD-LTX) for determination of impaired glucose tolerance. Methods: Recipients and donors without overt diabetes mellitus were investigated longitudinally before and on day 10, month 6 and month 12 after right lobectomy or liver transplantation of the right lobe. Insulin sensitivity (SI) was assessed by a computer-assisted analysis of a frequently sampled intravenous glucose tolerance test with 300 mg/kg BW glucose 50% (Konrad et al., 1999). (%cell responsiveness (first and second phase of pancreatic (i-cell secretion, Phi 1 and Phi 2) was determined by a c-peptide modeling analysis (SAAM 11 software). Conventional parameters (fasting glucose, insulin, c-peptide, HOMA-IR score) were correlated with modeling results. Results: Donors developed insulin resistance by day 10 (S1 2.65&0.41 10-4 min-1 pU ml-1 vs. 4.90&0.50 10-4 min-1 pU ml-1 in control, p < 0.01; Phi 2 increased which was normalized again by month 6 and 12. In contrast to healthy donors, recipients were insulin resistant prior to transplantation (SI 1.91+0.29 10-4 min-l pU ml-I, p i 0 . 0 I ) . There was no significant correlation between SI and fasting glucose, but significant correlations to fasting insulin, c-peptide, and HOMA-IR (p i 0.001). Discussion: Impaired glucose tolerance in cirrhosis was normalized by liver transplantation of the right lobe. Liver resection of the right lobe in donors leads to acute insulin resistance. Impaired glucose tolerance could not be predicted by fasting glucose. The reason for this is relative undernourishment of recipients before transplantation. Additional parameters such as fasting insulin, c-peptide, or HOMA-IR are necessary. Transplantution Surgery, Churit4, Berlin; ’Institute ,ft)r Mrtuholic