The internal disease post-OLT is the important factor that can influence the long-term survival of the patients, which includes diabetes mellitus, hypertension, hyperlipemia.
（一）Post Transplantation Diabetes Mellitus PTDM
Criteria of PTDM
PTDM: typical DM symptoms and/or high blood sugar concentration (fasting blood sugar>7.0mmol/L, blood sugar>11.1mmol/L or OGTT 2nd hour blood sugar>=11.1mmol/L)
abnormal sugar tolerance: fasting blood sugar, 6.1-6.9mmol/L or OGTT 7.8-11.1mmol/L
normal sugar tolerance: fasting blood sugar<6.1mmol/L or OGTT < 7.8mmol/L
Definition of PTDM:
fasting blood sugar>7.8, at least for 3 times, 10 weeks-12 months post-OLT, OGTT positive, insulin treatment for continuous 30 days or more, no DM pre-OLT.
etiology: multifactor, impairment of islets of Langerhans and β cells, insulin resistance
high risk factors of PTDM: immunosuppressant, steroids, blood sugar level before OLT, age, body weight, history or family history of DM
Influence of PTDM to patients
rising infection rate, cardiovascular complications, kidney disease, retina disease, impairment of graft, shortening of life span.
DM post-OLT
incidence: 13.6%~ 33%, most occurs on the firs 3 months, or the first year post-OLT, but the longest interval can be 4~5 yrs, 1/3~1/2 patients can relieve automatically
prevention of PTDM, chose of proper immunosuppressant, decrease the dosage of immunosuppressant, decrease both the dosage and the duration of steroids.
treatment of PTDM
①strictly fasting blood sugar control: < 6.7 mmol/L, HbA1C<7%
②blood pressure control: incidence, 33%~ 90%, <130/80mmHg
③others, such low lipid diet, etc.