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

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.