Multitime-point monitoring and analysis of influencing factors of early postoperative blood glucose and lipid levels in pediatric liver transplantation

doi:10.3969/j.issn.1674-8115.2025.04.006

Abstract

Abstract:

Objective ·To monitor postoperative blood glucose (BG) and blood lipids (BL) at multiple time points in pediatric patients undergoing liver transplantation (LT) and to analyze the influencing factors. Methods ·An observational study was conducted, including pediatric LT patients from the Hepatic Surgery Department of Renji Hospital, Shanghai Jiao Tong University School of Medicine. Blood samples were collected one day before surgery and on days 1, 7, and 14 after surgery. Basic patient information and laboratory indicators were recorded, including complete blood count (CBC), cytochrome P450 (CYP) genotyping, tacrolimus dosage (TD), tacrolimus serum drug level (TSDL), fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG), and biochemical testing for liver transplantation (BTLT). BTLT included the following indicators: total protein (TP), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), transglutaminase (GGT), direct bilirubin (DBil), total bilirubin (TBil), creatinine (Cr), triglyceride (TAG), total cholesterol (TC), prothrombin time (PT), and international normalized ratio (INR). The t-test or Mann-Whitney U test was used to analyze factors influencing PBG, Cox regression analysis was used to analyze factors influencing FBG, and logistic regression analysis was used to analyze factors influencing TC. Results ·A total of 82 pediatric LT patients were included, with 45 males (54.9%) and 37 females (45.1%). The average age was 7 months, average height was 65 cm, and average body weight was 7.15 kg. FBG [(6.54±1.71) mmol/L] and PBG [(7.42±2.19) mmol/L] reached their highest values on the first postoperative day and gradually decreased to normal levels. There were 59 patients in the normal FBG and PBG groups and 23 in the abnormal groups. TAG [(0.93±0.63) mmol/L] and TC [(1.91±1.08) mmol/L] reached their lowest values on the first postoperative day and then slowly increased. The t-test indicated that TP (P=0.050), AKP (P=0.020), GGT (P=0.002), TC (P=0.017), and TD (P=0.028) showed statistically significant differences between the normal and abnormal PBG groups. Cox regression analysis showed that gender (HR=0.501, 95% CI 0.184‒1.361), age (HR=0.972, 95% CI 0.876‒1.079), height (HR=1.012, 95% CI 0.903‒1.135), body weight (HR=1.067, 95% CI 0.720‒1.579), and blood type (A type HR=1.294, 95% CI 0.464‒3.612; B type HR=1.303, 95% CI 0.456‒3.723; AB type HR=1.520, 95% CI 0.310‒7.441) did not significantly affect the BG's time change process. Logistic regression analysis showed that the patient's CYP (1×3 OR=9.332, 95% CI 0.960‒90.719; 3×3 OR=18.083, 95% CI 1.414‒231.219) was a factor influencing TC. Conclusion ·TD is a factor influencing PBG on the first postoperative day, and the patient's CYP is a factor influencing TC on the same day.

Key words: liver transplantation, pediatrics, blood glucose, blood lipids, impact factors

CLC Number:

R575

LU Yefeng, GAO Leiqing, NI Xiaoxiao, FU Jingjing. Multitime-point monitoring and analysis of influencing factors of early postoperative blood glucose and lipid levels in pediatric liver transplantation[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(4): 443-451.

Figures/Tables 5

TrendMD

References 22

1	夏强, 朱欣烨. 儿童肝移植发展现状及展望[J]. 临床小儿外科杂志, 2022, 21(5): 401-404.
	XIA Q, ZHU X Y. Current development and future outlook of pediatric liver transplantation[J]. Journal of Clinical Pediatric Surgery, 2022, 21(5): 401-404.
2	尚莹, 邵非, 孔心涓. 成人原位肝移植术后糖尿病发生的危险因素分析[J]. 精准医学杂志, 2024, 39(4): 341-345,351.
	SHANG Y, SHAO F, KONG X J. An analysis of risk factors for the development of diabetes mellitus after orthotopic liver transplantation in adults[J]. Journal of Precision Medicine, 2024, 39(4): 341-345,351.
3	陆晔峰, 陈国立, 富晶晶. 儿童肝移植术后血糖水平的监测及其影响因素[J]. 肝脏, 2024, 29(3): 332-337.
	LU Y F, CHEN G L, FU J J. Post-pediatric liver transplant: blood glucose monitoring and influencing factors analysis[J]. Chinese Hepatology, 2024, 29(3): 332-337.
4	李姗霓, 郑虹. 美国儿童肝移植术后代谢综合征的特点[J]. 实用器官移植电子杂志, 2019, 7(3): 236-240.
	LI S N, ZHENG H. Characteristics of metabolic syndrome in children after liver transplantation in the United States[J]. Practical Journal of Organ Transplantation (Electronic Version), 2019, 7(3): 236-240.
5	中华医学会儿科学分会罕见病学组, 中华医学会儿科学分会心血管学组, 中华医学会儿科学分会儿童保健学组, 等. 儿童脂质异常血症诊治专家共识(2022)[J]. 中华儿科杂志, 2022, 60(7): 633-639.
	Subspecialty Group of Rare Diseases, Society of Pediatrics, Chinese Medical Association, Subspecialty Group of Cardiology, Society of Pediatrics, Chinese Medical Association, Subspecialty Group of Child Health Care, Society of Pediatrics, Chinese Medical Association, et al. Expert consensus on diagnosis and management of dyslipidemia in children (2022)[J]. Chinese Journal of Pediatrics, 2022, 60(7): 633-639.
6	张利姗, 于瑞, 叶海丹. 基于扫描式葡萄糖监测系统分析肝移植受者术后血糖变化情况[J]. 齐齐哈尔医学院学报, 2024, 45(11): 1089-1092.
	ZHANG L S, YU R, YE H D. Analysis of postoperative blood glucose variation in liver transplant recipients based on flash glucose monitoring system[J]. Journal of Qiqihar Medical College, 2024, 45(11): 1089-1092.
7	崔蕾, 段怡, 高志峰, 等. 术中严格血糖控制对肝移植术患者术后肝功能障碍的影响[J]. 中华麻醉学杂志, 2024, 44(5): 548-552.
	CUI L, DUAN Y, GAO Z F, et al. Effect of strict intraoperative blood glucose control on postoperative hepatic allograft dysfunction in patients undergoing liver transplantation[J]. Chinese Journal of Anesthesiology, 2024, 44(5): 548-552.
8	孟园园, 段怡, 高志峰, 等. 肝移植患者术中血糖变异系数对术后早期移植物功能障碍的影响[J]. 临床麻醉学杂志, 2022, 38(12): 1254-1258.
	MENG Y Y, DUAN Y, GAO Z F, et al. Effect of intraoperative glycemic of variation on early allograft dysfunction in patients undergoing liver transplantation[J]. Journal of Clinical Anesthesiology, 2022, 38(12): 1254-1258.
9	段怡, 崔蕾, 陈晔, 等. 术中血糖变异度与不良预后相关性的研究进展[J]. 临床麻醉学杂志, 2022, 38(9): 976-979.
	DUAN Y, CUI L, CHEN Y, et al. Research progress on correlation between increased intraoperative glucose variability and poor prognosis[J]. Journal of Clinical Anesthesiology, 2022, 38(9): 976-979.
10	张杰, 仇焕容. 肝糖原累积症儿童行肝脏移植手术围手术期酸碱平衡和血糖特征[J]. 临床和实验医学杂志, 2020, 19(24): 2618-2622.
	ZHANG J, QIU H R. The acid base balance and blood glucose management during liver transplantation in patients with glycogen storage diseases[J]. Journal of Clinical and Experimental Medicine, 2020, 19(24): 2618-2622.
11	戴旻晖, 颜鲲, 陆璨. 儿童肾移植术中不同输液溶液对血糖的影响[J]. 中国当代儿科杂志, 2011, 13(7): 595-597.
	DAI M H, YAN Kun, LU C. The effect of different infusion solutions on blood glucose during pediatric kidney transplantation[J]. Chinese Journal of Contemporary Pediatrics, 2011, 13(7): 595-597.
12	刘芹凤, 刘兆勇. 糖尿病患者围术期行全身麻醉和硬膜外麻醉对其血糖的影响因素[J]. 糖尿病新世界, 2024, 27(1): 43-46.
	LIU Q F, LIU Z Y. Analysis on the influence of perioperative general anesthesia and epidural anesthesia on blood glucose in diabetic patients[J]. Diabetes New World, 2024, 27(1): 43-46.
13	肖正楠, 李俊辉, 蒋捷, 等. 肝移植术后糖尿病的最新进展[J]. 器官移植, 2021, 12(5): 630-636.
	XIAO Z N, LI J H, JIANG J, et al. Recent progress on diabetes mellitus after liver transplantation[J]. Organ Transplantation, 2021, 12(5): 630-636.
14	梁欣, 欧志宇, 苗芸. 实体器官移植术后谵妄的研究进展[J]. 器官移植, 2024, 15(6): 958-963.
	LIANG X, OU Z Y, MIAO Y. Research progress of delirium after solid organ transplantation[J]. Organ Transplantation, 2024, 15(6): 630-636.
15	成人实体器官移植后糖尿病管理专家共识[J]. 器官移植, 2023, 14(5): 623-642.
	Organ transplantation and rehabilitation committee of Chinese medical association of rehabilitation[J]. Expert consensus on diabetes mellitus after solid organ transplantation in adults. Organ Transplantation, 2023, 14(5): 623-642.
16	卢晓哲, 李卫芹, 乔毅娟, 等. 天津市5-6岁儿童空腹血糖现状及影响因素分析[J]. 中国儿童保健杂志, 2022, 30(7): 715-719.
	LU X Z, LI W Q, QIAO Y J. Current status and influencing factors of fasting plasma glucose of children aged 5‒6 years in Tianjin[J]. Chinese Journal of Child Health Care, 2022, 30(7): 715-719.
17	SARNO G, MEHTA R J, GUARDADO-MENDOZA R, et al. New-onset diabetes mellitus: predictive factors and impact on the outcome of patients undergoing liver transplantation[J]. Curr Diabetes Rev, 2013, 9(1): 78-85.
18	SALIBA F, LAKEHAL M, PAGEAUX G H, et al. Risk factors for new-onset diabetes mellitus following liver transplantation and impact of hepatitis C infection: an observational multicenter study[J]. Liver Transpl, 2007, 13(1):136-144.
19	李涛, 张曼. 基于Cox回归分析筛选2型糖尿病肾病发生的危险因素[J]. 标记免疫分析与临床, 2023, 30(10): 1649-1653.
	LI T, ZHANG M. An analysis of risk factors for the development of type 2 diabetic kidney disease based on cox regression analysis[J]. Labeled Immunoassays and Clinical Medicine, 2023, 30(10): 1649-1653.
20	叶少炜, 钱均霖, 胡泽民. 肝移植后代谢综合征及其防治的研究进展[J]. 岭南现代临床外科, 2022, 22(2): 199-204.
	YE S W, QIAN J L, HU Z M. Research progress on metabolic syndrome and its prevention and treatment after liver transplantation[J]. Lingnan Modern Clinics in Surgery, 2022, 22(2): 199-204.
21	中华医学会器官移植学分会. 中国实体器官移植受者血脂管理规范(2019 版) [J]. 器官移植, 2019, 10(2): 101-111.
	Branch of Organ Transplantation, Chinese Medical Association. Blood lipid management standards for Chinese solid organ transplant recipients (2019 edition)[J]. Organ Transplantation, 2019, 10(2): 101-111.
22	吴懿, 蒋巍亮, 杨晓军, 等. 肝移植受者术后早期血清甘油三酯变化规律及其对术后糖尿病的预测价值[J]. 浙江大学学报(医学版), 2021, 50(2): 239-244.
	WU Y, JIANG W L, YANG X J, et al. Postoperative serum triglyceride levels in predicting risk of new-onset diabetes mellitus in patients following liver transplantation[J]. Journal of Zhejiang University (Medical Sciences), 2021, 50(2): 239-244.

Indicator	Cohort (n=82)	Abnormal group (n=23)	Normal group (n=59)
Gender/(n%)
Male	45 (54.9)	17 (73.9)	28 (47.5)
Female	37 (45.1)	6 (26.1)	31 (52.5)
Age of operation/month	7.00 (5.00, 11.50)	7.50 (5.25, 13.00)	6.00 (5.00, 10.50)
Height/cm	65.00 (62.00, 72.00)	65.00 (63.00, 79.00)	65.00 (62.00, 71.50)
Weight/kg	7.15 (6.00, 8.75)	7.30 (6.40, 10.67)	7.10 (5.85, 8.30)
BMI/(kg·m^-2)	15.95 (14.48, 17.19)	16.35 (14.72, 17.74)	15.59 (14.29, 17.04)
GRWR	3.70 (3.02, 4.39)	3.81 (2.56, 4.21)	3.71 (3.15, 4.47)
Blood type of recipient/(n%)
O	21 (25.6)	4 (17.4)	17 (28.8)
A	24 (29.3)	8 (34.8)	16 (27.1)
B	29 (35.4)	6 (26.1)	23 (39.0)
AB	8 (9.8)	5 (21.7)	3 (5.1)
Blood type of donor/(n%)
O	24 (29.3)	4 (17.4)	20 (33.9)
A	22 (26.8)	9 (39.1)	13 (22.0)
B	30 (36.6)	8 (34.8)	22 (37.3)
AB	6 (7.3)	2 (8.7)	4 (6.8)
Blood type compatibility/(n%)
Yes	13 (15.9)	2 (8.7)	11 (18.6)
No	69 (84.1)	21 (91.3)	48 (81.4)
CYP genotyping of recipient/(n%)
1×1	9 (11.0)	1 (4.4)	8 (13.6)
1×3	37 (45.1)	11 (47.8)	26 (44.0)
3×3	36 (43.9)	11 (47.8)	25 (42.4)
CYP genotyping of donors/(n%)
1×1	8 (9.8)	3 (13.0)	5 (8.5)
1×3	28 (34.1)	6 (26.1)	22 (37.3)
3×3	46 (56.1)	14 (60.9)	32 (54.2)
Whether mycophenolate mofetil was administered/(n%)
Yes	18 (22.0)	4 (17.4)	14 (23.7)
No	64 (78.0)	19 (82.6)	45 (76.3)
Occurrence of CMV infection/(n%)
Yes	13 (15.9)	9 (39.1)	4 (6.8)
No	69 (84.1)	14 (60.9)	55 (93.2)

Indicator	Cohort (n=82)	Abnormal group (n=23)	Normal group (n=59)
Gender/(n%)
Male	45 (54.9)	17 (73.9)	28 (47.5)
Female	37 (45.1)	6 (26.1)	31 (52.5)
Age of operation/month	7.00 (5.00, 11.50)	7.50 (5.25, 13.00)	6.00 (5.00, 10.50)
Height/cm	65.00 (62.00, 72.00)	65.00 (63.00, 79.00)	65.00 (62.00, 71.50)
Weight/kg	7.15 (6.00, 8.75)	7.30 (6.40, 10.67)	7.10 (5.85, 8.30)
BMI/(kg·m^-2)	15.95 (14.48, 17.19)	16.35 (14.72, 17.74)	15.59 (14.29, 17.04)
GRWR	3.70 (3.02, 4.39)	3.81 (2.56, 4.21)	3.71 (3.15, 4.47)
Blood type of recipient/(n%)
O	21 (25.6)	4 (17.4)	17 (28.8)
A	24 (29.3)	8 (34.8)	16 (27.1)
B	29 (35.4)	6 (26.1)	23 (39.0)
AB	8 (9.8)	5 (21.7)	3 (5.1)
Blood type of donor/(n%)
O	24 (29.3)	4 (17.4)	20 (33.9)
A	22 (26.8)	9 (39.1)	13 (22.0)
B	30 (36.6)	8 (34.8)	22 (37.3)
AB	6 (7.3)	2 (8.7)	4 (6.8)
Blood type compatibility/(n%)
Yes	13 (15.9)	2 (8.7)	11 (18.6)
No	69 (84.1)	21 (91.3)	48 (81.4)
CYP genotyping of recipient/(n%)
1×1	9 (11.0)	1 (4.4)	8 (13.6)
1×3	37 (45.1)	11 (47.8)	26 (44.0)
3×3	36 (43.9)	11 (47.8)	25 (42.4)
CYP genotyping of donors/(n%)
1×1	8 (9.8)	3 (13.0)	5 (8.5)
1×3	28 (34.1)	6 (26.1)	22 (37.3)
3×3	46 (56.1)	14 (60.9)	32 (54.2)
Whether mycophenolate mofetil was administered/(n%)
Yes	18 (22.0)	4 (17.4)	14 (23.7)
No	64 (78.0)	19 (82.6)	45 (76.3)
Occurrence of CMV infection/(n%)
Yes	13 (15.9)	9 (39.1)	4 (6.8)
No	69 (84.1)	14 (60.9)	55 (93.2)

Indicator	T0	T1	T7	T14
FBG/(mmol·L^-1)	4.45±0.79	6.54±1.71	5.20±1.85	3.89±1.15
PBG/(mmol·L^-1)	5.58±1.11	7.42±2.19	6.47±1.86	5.7±1.48
TAG/(mmol·L^-1)	1.54±1.14	0.93±0.63	1.19±0.63	1.66±0.72
TC/(mmol·L^-1)	5.77±4.04	1.91±1.08	1.99±0.50	2.36±0.71

Indicator	T0	T1	T7	T14
FBG/(mmol·L^-1)	4.45±0.79	6.54±1.71	5.20±1.85	3.89±1.15
PBG/(mmol·L^-1)	5.58±1.11	7.42±2.19	6.47±1.86	5.7±1.48
TAG/(mmol·L^-1)	1.54±1.14	0.93±0.63	1.19±0.63	1.66±0.72
TC/(mmol·L^-1)	5.77±4.04	1.91±1.08	1.99±0.50	2.36±0.71

Indicator	Normal group (n=59)	Abnormal group (n=23)	P value
TP/(g·L^-1)	52.61±6.28	51.81±6.91	0.050
ALB/g·L^-1)	43.64±6.17	43.33±6.81	0.436
ALT/(U·L^-1)	546.78±399.98	442.48±189.19	0.447
AST/(U·L^-1)	496.74±347.17	434.13±179.91	0.997
AKP/(U·L^-1)	182.74±125.97	176.61±93.14	0.020
GGT/(U·L^-1)	107.36±91.25	121.00±90.53	0.002
DB/(μmol·L^-1)	48.00±29.63	51.43±29.09	0.365
TB/(μmol·L^-1)	81.52±44.26	95.65±54.07	0.118
Cr/(μmol·L^-1)	14.00 (12.00, 17.00)	14.00 (11.00, 17.00)	0.530
TAG/(mmol·L^-1)	0.94±0.70	0.92±0.43	0.996
TC/(mmol·L^-1)	1.80±0.83	2.18±1.52	0.017
PT/s	21.55 (20.38, 25.60)	22.20 (18.70, 27.20)	0.847
INR	1.93 (1.84, 2.33)	2.03 (1.67, 2.34)	0.938
TD/mg	0.98±0.16	0.98±0.18	0.028
TSDL/(ng·ml^-1)	4.95±2.48	3.93±1.51	0.402