Alterations in glucose metabolism associated with liver cirrhosis persist in the clinically stable long-term course after liver transplantation
Authors: Tietge Uwe J.F. , Selberg Oliver , Kreter Andreas , Bahr Matthias J. , Pirlich Matthias , Burchert Wolfgang , Müller Manfred J. , Manns Michael P. , Böker Klaus H.W. 
Published: July 2004

With increasing long-term survival rates after orthotopic liver transplantation (OLT), metabolic alterations complicating the clinical course, such as diabetes mellitus (DM), become increasingly important. Liver cirrhosis is associated with severe alterations in glucose metabolism. However, it is currently unclear whether these changes are reversed by successful OLT. We therefore characterized glucose metabolism in patients with liver cirrhosis and normal fasting glucose levels before OLT (cir), in the clinically stable long-term course after OLT (OLT), and control subjects (con) using oral glucose tolerance tests (cir = 100, OLT = 62, con = 32), euglycemic-hyperinsulinemic clamps (cir = 10, OLT = 27, con = 14), and positron emission tomography (PET) scan analysis with 18F-fluorodeoxyglucose (FDG) as a tracer (cir = 7, OLT = 7, con = 5). Fasting insulin and C-peptide levels were significantly elevated in patients with liver cirrhosis compared with both control subjects (P < .001) and patients after OLT (P < .001). After OLT, insulin was normalized, whereas C-peptide remained elevated (P < 0.01). In the patients with liver cirrhosis, 27% had a normal glucose tolerance, 38% had an impaired glucose tolerance (IGT), and 35% were diabetic. After OLT, 34% had a normal glucose tolerance, 29% an IGT, and 37% were diabetic. Comparison of the same patients before and after OLT demonstrated that IGT or diabetes before OLT was the major risk factor for these conditions after OLT, which was independent of either immunosuppression (cyclosporine vs FK506) or low-dose prednisolone. Total glucose uptake was reduced in patients with liver cirrhosis to less than half the values in control subjects (21.2 ± 2.8 vs 43.7 ± 2.4 μmol/kg/minute, respectively, P < .001), whereas patients after OLT showed intermediate values (35.7 ± 1.4 μmol/kg/minute, P < 0.05 vs con, P < 0.01 vs cir). This difference was caused by a reduction in nonoxidative glucose metabolism in patients with liver cirrhosis compared with control subjects (7.4 ± 1.9 vs 28.7 ± 1.8 μmol/kg/minute, respectively, P < .01) and patients after OLT (20.1 ± 1.4 μmol/kg/minute, P < 0.05 vs con and OLT). In the PET study, skeletal muscle glucose uptake was significantly reduced in patients with liver cirrhosis compared with control subjects (3.5 ± 0.4 vs 11.8 ± 2.5 μmol/100g/minute, respectively, P < .05). After OLT, muscle glucose uptake improved compared with patients with liver cirrhosis (5.9 ± 1.0 μmol/100g/minute, P < .05) but remained significantly lower than in control subjects (P < .05). In conclusion, these results demonstrate that preexisting IGT or diabetes are the major risk factors for IGT and diabetes after OLT. This finding was independent of the immunosuppressive medication. The peripheral insulin resistance in cirrhosis is characterized by a decrease in nonoxidative glucose disposal that is improved, but not normalized, after OLT. (Liver Transpl 2004;10:1030-1040.)