Early peri-operative glycaemic control and allograft rejection in patientswith diabetes mellitus: A pilot study

Background. Hyperglycemia alters the inflammatory response to infection and ischemia. We hypothesize that perioperative glycemic control could also in fluence the risk for allograft rejection. Methods. Consecutive patients with established diabetes undergoing their fi rst cadaveric renal transplantation and receiving steroid-sparing immunosup pression were identified (n=50). Records of capillary glucose observations over the first 100 hr following surgery and transplantation variables perta ining to graft function, acute rejection, and postoperative infection were identified and entered into multivariate analysis. Results. Perioperative glycemic control was associated with an increased in cidence of infection and acute rejection. Only 3 of 27 patients (11%) with optimal glycemic control during the 100 hr following surgery (mean < 11.2 m mol/L) had rejection episodes compared with 58% of patients with poor contr ol (>11.2 mmol/L). All patients with poor glycemic control experienced post operative infection. Conclusions. This pilot study suggests that hyperglycemia may be associated with an increased risk of both allograft rejection and postoperative infec tion in patients with diabetes.