The impact of diabetes mellitus at the time of heart transplantation on long-term survival

Abstract

Aims/hypothesis. To analyse the impact of diabetes mellitus (DM) at the time of heart transplantation on long-term survival and incidence of transplant coronary artery disease (TxCAD). Methods. We analysed 773 consecutive adult heart transplant recipients who underwent primary heart transplantation from May 1986 until December 2000. The cohort consisted of 140 patients with diabetes mellitus (with DM, men 82%) and 633 patients without (wo DM, men 84%) diabetes mellitus at the time of transplantation. The patients were documented as to survival and incidence of TxCAD. Results. Patients with diabetes mellitus were older compared to those without diabetes mellitus (with DM 54.9±6.8a vs wo DM 49.7±10.8a; p=0.0001), they had a higher incidence of ischaemic cardiomyopathy prior to transplantation (with DM 52% vs wo DM 30%; p=0.0001), but reduced long-term survival (10 year survival: with DM 40% vs wo DM 58%; logrank=0.025). Surprisingly, the incidence of transplant coronary artery disease (TxCAD) was comparable at 10 years (with DM 28% vs wo DM 22%; logrank=0.625). In multivariate Cox proportional hazard analysis, diabetes mellitus present at the time of heart transplantation (HR 1.594; 95%CI 1.009-2.518; p=0.045), but not age (HR 0.990; 95%CI 0.965-1.014; p=0.404) was an independent predictor affecting long-term survival. Conclusion/interpretation. The presence of diabetes mellitus at the time of heart transplantation adversely affects long-term patient survival, but does not predict the occurrence of transplant coronary artery disease. The definite mechanisms of adverse survival primarily seem to relate to generally impaired global organ function. Despite a less favourable long-term outcome, our data still justify heart transplantation in end-stage heart failure patients with diabetes mellitus.

Hurdles to Cardioprotection in the Critically Ill

“…In comparison to TAC, CsA appears to potentiate hyperlipidemia and hypertension post-HTx more, two risk factors that contribute to CAV development. Tacrolimus has also been associated with the development of new-onset diabetes and impaired glucose tolerance following both heart and renal transplant [175,184,194,195,196,197,198]. Despite these cardiovascular and metabolic complications, TAC and CsA have notably improved medium-term longevity and are equally effective at limiting acute rejection post-HTx [184,194,199].…”

Current Trends in Heart Transplantation

“…Although the presence of diabetes mellitus at the time of transplantation seems to impact on the long-term survival, the data still justify offering heart transplantation to diabetic patients with end-stage heart failure [36]. Czerny et al [36]analyzed 773 consecutive primary adult heart transplant recipients at their institution.…”

“…Czerny et al [36]analyzed 773 consecutive primary adult heart transplant recipients at their institution. Of those, 140 patients had diabetes and 633 did not have diabetes at the time of transplantation.…”

“…However, the presence of diabetes at the time of transplantation was associated with reduced long-term survival at 10 years (40 versus 58%, respectively, log-rank = 0.025). Multivariate Cox proportional hazard analysis performed by these authors showed that diabetes but not age was an independent predictor affecting long-term survival [36]. …”

Management of the Hospitalized Transplant Patient

“…Diabetes is the most common cause of end-stage renal disease and need for kidney transplant in the USA [6–8]. Diabetes is also present in 14–22 % of heart transplant recipients [9–11] and up to a quarter of liver transplant recipients [12, 13•]. Obesity is also very common in transplant populations.…”