A new challenge for linagliptin: diabetes, organ transplantation and chronic renal insufficiency in the same patient

The association between liver cirrhosis and type 2 diabetes mellitus (DMT2) has been known for many years. It is estimated that changes in glucose metabolism are present in at least two thirds of cirrhosis patients. Diabetes can be both a consequence of liver disease and a pre-existing condition. In the first case, liver transplantation would be the solution but post-transplant diabetes remains a common condition. For patients with liver cirrhosis the therapeutic approach for the treatment of DMT2 is extremely limited and the studies available on this type of population are very few. The pharmacokinetic characteristics of linagliptin are well suited for patients with DMT2 and chronic liver disease; in fact, no dose adjustment is required in patients regardless of the degree of hepatic impairment. With regard to the treatment of diabetes in post-transplantation, data on the efficacy and safety of oral hypoglycemic drugs are scarce; however, the available studies suggest that dipeptidyl peptidase 4 (DPP4i) inhibitors are safe and effective in these patients. In describing this clinical case, we discuss how the use of a DPP4i, and in particular of linagliptin, may represent a valid therapeutic strategy in the management of diabetic, cirrhotic patients who undergo liver transplantation (Diabetology).