Peak insulin drip rate associated with decreased infections post-solid organ transplant.

Abstract

Infection and rejection outcomes were retrospectively analyzed in patients following liver transplant and separately following heart transplant with patients being stratified by their severity of immediate postoperative insulin resistance as measured by the peak insulin drip rate that was required to reduce glucose levels. For each group, these peak insulin drip rates were divided into quartiles (Q). In liver transplant patients (n=207), those in Q4 (highest infusion rate) had significantly fewer infections up to 6 months post-transplant (42.3%vs. 60.0%, p=.036) and borderline fewer rejection episodes (25.0%vs. 40.0%, p=.066) compared to Q1-Q3 patients. To confirm these unexpected results, a subsequent similar analysis in heart transplant (n=188) patients again showed that Q4 patients had significantly fewer infections up to 6 months (19.1%vs. 53.9%, p<.0001) compared to Q1-Q3 patients. Logistic regression in a subset of 103 cardiac transplant patients showed that the maximum glucose during surgery, prior MI, and hypertension were associated with severe insulin resistance (SIR) status, while the presence of pre-existing diabetes and BMI were not. We hypothesize that patients are who are able to mount a more robust counter-regulatory response that causes the insulin resistance may be healthier and thus able to mount a better response to infections.