Many
liver transplant recipients experience intraoperative
hyperglycemia after graft reperfusion. Accordingly, we introduced the Portland intensive
insulin therapy (PoIIT) in our practice to better
control blood glucose concentration (BGC). We evaluated the effects of PoIIT by comparing with our conventional
insulin therapy (CoIT). Of 128 patients who underwent living donor
liver transplantation (LDLT) during the phaseout period of CoIT, 89 were treated with the PoIIT and 39 were treated with CoIT. The primary outcome was
hyperglycemia (BGC > 180 mg/dL) during the intraoperative postreperfusion phase. The secondary outcomes were postoperative complications such as
infection. The incidence of
hyperglycemia (22.5% vs. 53.8%, p = 0.001) and prolonged
hyperglycemia for >2 hours (7.9% vs. 30.8%, p = 0.002) was significantly lower in PoIIT group than in CoIT group. A mixed linear model further demonstrated that repeatedly measured BGCs were lower in PoIIT group (p < 0.001). The use of PoIIT was significantly associated with decreases in major
infections (OR = 0.23 [0.06-0.85], p = 0.028), prolonged
mechanical ventilation (OR = 0.29 [0.09-0.89], p = 0.031), and biliary
stricture (OR = 0.23 [0.07-0.78], p = 0.018) after adjustments for age, sex, and
diabetes mellitus. In conclusion, the PoIIT is effective for maintaining BGC and preventing
hyperglycemia during the intraoperative postreperfusion phase of living donor
liver transplantation with potential clinical benefits.