Real-Time Continuous Glucose Monitoring Improves Glycemic Control in the Early Postoperative Period Following Liver...

Early postoperative glycemic control after orthotopic liver transplantation (OLTx) is challenging because of surgical stress, corticosteroid and calcineurin-inhibitor immunosuppression, and parenteral nutrition. We evaluated whether adding real-time continuous glucose monitoring (rtCGM) to standard care increases time in the target glucose range.

In this single-center randomized controlled trial, OLTx recipients were randomized after surgery to open (Active) or blinded (Control) rtCGM (Dexcom G6); in the Active group, sensor data guided insulin titration. The primary endpoint was time in target range (TIR, 6.0-10.0 mmol/L), analyzed in a modified intention-to-treat population. Secondary endpoints included glycemic metrics, insulin requirements, and predefined clinical outcomes.

We randomized 154 patients; 142 with available data were analyzed (82 Active, 60 Control). The Active group spent more time in target range (68.9% vs. 60.8%; median difference 7.2 percentage points [95% CI: 2.7-12.0]; P = 0.003), with less time in Level 1 hyperglycemia (P = 0.025) and fewer extended hyperglycemic episodes (incidence rate ratio 1.65 [1.03-2.65] for Control vs. Active; P = 0.039). TIR improved similarly in patients with and without pretransplant diabetes; the only significant treatment-by-diabetes interaction was a greater reduction in Level 2 hyperglycemia among patients with diabetes (P < 0.001). Hypoglycemia was minimal in both groups. Infectious complications were less frequent in the Active group (45.1% vs. 63.3%; P = 0.041).

Adding rtCGM to standard postoperative care improved glycemic control after liver transplantation, with consistent benefit regardless of diabetes status and the greatest effect on Level 2 hyperglycemia in patients with diabetes. The lower infection rate is a hypothesis-generating finding warranting a dedicated trial.