Predictive Factors for Development of Diabetes Mellitus Post-Heart Transplant

Martínez‐Dolz, Luis; Almenar, Luís; Martínez-Ortiz, Luis; Arnau, Miguel Á.; Chamorro, C.; Moro, José; Osa, Ana; Rueda, Joaquı́n; García, Carlos Fernández; Palencia, M

doi:10.1016/j.transproceed.2005.09.161

Cited by 28 publications

(26 citation statements)

References 13 publications

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“…While steroids increase insulin resistance, tacrolimus also decreases insulin production 22 . In contrast to the majority of studies reporting significant impact of tacrolimus on development of post-transplantation diabetes [23][24][25] , we found a no higher incidence of post-transplantation diabetes in our selection of patients treated with tacrolimus than patients treated with cyclosporin. This result agrees with the results of recently published DIRECT-trial (Diabetes incidence after renal transplantation: Neoral C2 monitoring versus Tacrolimus).…”

Section: Discussioncontrasting

confidence: 99%

Impact of Diabetes Mellitus on Survival Rates After Heart Transplantation

Bedáňová¹,

Ondrášek²,

Černý³

et al. 2009

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims: Heart transplantation (HTx) is the most effective therapy in patients with end-stage heart failure. Diabetesrelated complications are relative contraindications for heart transplantation. The aim of our study was to analyse the impact of DM (diabetes mellitus) at the time of heart transplantation and new-onset post-transplantation DM on long-term survival.Methods: A retrospective database analysis was performed on all patients who had undergone HTx at our institution between 4/1997 and 9/2007. Patients were divided into three groups: Group A -patients without DM; Group B -patients with new onset of DM after HTx; Group C -patients with DM prior to HTx.Results: Patients with DM before the surgery were more obese, their BMI was 27.7 ± 2.90, compared to groups A and B with BMI of 24.7 ± 3.37 and 25.3 ± 3.64 respectively (p = 0.0003). Patients in group B had statistically significantly higher risk of developing acute rejection (G 1B and more according to International Society of Heart and Lung Transplantation -ISHLT -classification) (p = 0.0350). The incidence of infections between individual groups showed no statistically significant differences (p = 0.5839). Five-year survival in group A was 82%, 10-year survival was 73%. Corresponding numbers for group B were 86% and 78%, for group C 86% and 83%. Differences between groups were not statistically significant (p = 0.2560).Conclusions: DM in patients after heart transplantation in our study had no effect on long-term survival of patients. Post-transplantation DM increases risk of acute rejections. Pre-transplantation DM was associated with excessive bodyweight or obesity.

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Section: Discussioncontrasting

confidence: 99%

Impact of Diabetes Mellitus on Survival Rates After Heart Transplantation

Bedáňová¹,

Ondrášek²,

Černý³

et al. 2009

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Several studies 53–56 have documented the relationship between heavier pre-HT patient weight and the development of post-HT diabetes, but only 2 studies 16,17 were found that reported an association between higher post-HT BMI and new-onset diabetes, due to the higher prednisone intake early after transplant, thus supporting our finding.…”

Section: Discussionsupporting

confidence: 72%

“…Higher post-HT BMI was also related to the development of post-transplant cardiac allograft vasculopathy (CAV) 12–15 and steroid-induced diabetes, 16,17 as well as graft failure. 18 In addition, Grady et al 19 reported more episodes of acute rejection in heavier post-HT patients.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes in overweight heart transplant recipients

2016

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Background There is a paucity of research examining the impact of patient weight after heart transplant (HT) on multiple clinical outcomes. Objectives The purpose of this study was to compare 9 clinical outcomes in 2 groups of HT recipients (N = 347) from 2 hospitals in the midwestern and southern United States, based on their mean body mass index (BMI) during the first 3 years post-HT, and to identify risk factors for mortality. Methods The sample was divided into 2 groups: Group 1: 108 non-overweight patients (BMI <25; mean age 52; 29.6% females; 16.7% minorities), and Group 2: 239 overweight patients (BMI ≥25; mean age 52; 15.9% females; 13.8% minorities). Outcomes examined were: survival, re-hospitalization, rejections, infections, cardiac allograft vasculopathy (CAV), stroke, renal dysfunction, diabetes, and lymphoma. Results Non-overweight patients had shorter survival, were re-hospitalized more days after the HT discharge, and had more lymphoma and severe renal dysfunction. Overweight patients had more CAV, steroid-induced diabetes, and acute rejections. Mortality risk factors were: higher prednisone dose, higher cholesterol, earlier IV-treated infection, severe renal dysfunction, respiratory failure, and female patient. Conclusions Overweight HT patients had better survival, but more rejections, CAV, and diabetes. Non-overweight HT patients had worse survival, plus more re-hospitalization time, lymphoma, and renal dysfunction.

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“…It is interesting that tacrolimus has been implicated in the development of hepatoxicity and post-transplantation diabetes mellitus particularly in older patients. Between 24 to 33% of patients on tacrolimus develop diabetes [5,11,17]. The pathogenesis of post-transplant diabetes in these patients is not completely understood.…”

Section: Discussionmentioning

confidence: 99%

Liver glycogen bodies: ground-glass hepatocytes in transplanted patients

et al. 2006

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Ground-glass hepatocytes have been described in Lafora's disease, fibrinogen deposition, hepatitis B, type IV glycogenosis, and alcohol aversion (cyanamide) therapy. We encountered ground-glass hepatocytes with intracytoplasmic inclusions in four liver biopsies from three transplanted patients who had none of the above-mentioned underlying diseases. One patient was a 4-year-old boy who had a kidney transplant for severe ureterovesical reflux. Patient 2 was a 52-year-old man who had two liver transplants because of hepatitis C. The third patient was a 7-month-old girl who underwent a multivisceral transplant because of necrotizing enterocolitis and liver failure induced by total parenteral nutrition. The patients developed liver abnormalities from 45 days to 4 years after their transplants. The livers showed conspicuous ground-glass hepatocytes in 90% of the children's samples and 30% of the adult liver cells. The cytoplasmic bodies stained strongly for Gomori methenamine-silver; they were positive for periodic acid-Schiff without diastase, but negative after diastase digestion. They were negative for colloidal iron and hepatitis B core and surface antigens. Electron microscopy revealed non-membrane bound aggregates of glycogen. Idiopathic ground-glass hepatocytes occur in transplanted patients and represent accumulation of altered glycogen. However, their clinical significance and cause are not entirely elucidated.

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Predictive Factors for Development of Diabetes Mellitus Post-Heart Transplant

Cited by 28 publications

References 13 publications

Impact of Diabetes Mellitus on Survival Rates After Heart Transplantation

Impact of Diabetes Mellitus on Survival Rates After Heart Transplantation

Clinical outcomes in overweight heart transplant recipients

Liver glycogen bodies: ground-glass hepatocytes in transplanted patients

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