Usefulness of continuous blood glucose monitoring and control for patients undergoing liver transplantation

Background : The purpose of this study was to evaluate the usefulness of the closed-loop system (STG-22; Nikkiso, Tokyo, Japan), a type of artificial endocrine pancreas for the continuous monitoring and control of intraoperative blood glucose in patients undergoing liver transplantation. Methods : Sixteen patients undergoing livingdonor liver transplantation were enrolled in this study. Glucose levels were controlled with either a manual injection of insulin based on a commonly used sliding scale (manual insulin group, n= 8) or a programmed infusion of insulin determined by the control algorithm of the artificial endocrine pancreas (programmed insulin group, n= 8). The target glucose level range was set at 80-150 mg/dl. Results : The mean and SD of blood glucose concentration during surgery (Glu-Ave and Glu-SD, respectively) for the programmed insulin group were lower than for the manual insulin group. The coefficient of variability (Glu-CV=Glu-SD 100 / Glu-Ave) for the programmed insulin group was also lower than for the manual insulin group (20.1 +/- 4.9% vs. 26.9 6.1%; mean SD). No hypoglycemia was detected in either group. Conclusion : The STG-22 closed-loop system is effective for maintaining strict blood glucose control during liver transplantation with minimal variability in blood glucose concentration.