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Cardiac transplantation in patients with insulin-treated diabetes mellitus
G Tenderich1, S Schulte-Eistrup, R Petzoldt
1Herzzentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Insights
Cardiac transplantation is a viable option for patients with insulin-treated diabetes mellitus and end-stage heart failure. Careful management of diabetes and immunosuppression is crucial for successful outcomes in these patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Endocrinology
Background:
- Diabetic patients exhibit high cardiac mortality from coronary artery disease.
- Cardiac transplantation is a potential therapy for end-stage heart failure in diabetic individuals.
Purpose of the Study:
- To evaluate the outcomes of cardiac transplantation in patients with insulin-treated diabetes mellitus.
Main Methods:
- Retrospective analysis of 40 patients with insulin-treated diabetes mellitus (3 type-1, 37 type-2) undergoing cardiac transplantation between March 1989 and December 1996.
Main Results:
- Orthotopic cardiac transplantation was performed in 40 patients (mean age 56 years) with pre-existing diabetes mellitus.
- Overall mortality was 40.0%, with an early mortality of 12.5%.
Conclusions:
- Insulin-treated diabetes mellitus (type 1 or 2) is not a contraindication for heart transplantation.
- Optimal diabetes management and individualized immunosuppression are vital to minimize complications.
Background And Methods:
As documented earlier the incidence of cardiac mortality in diabetic patients due to coronary artery disease is high. Cardiac transplantation for congestive heart failure due to coronary artery disease, cardiomyopathy, and valvular diseases is obviously a therapeutic option in patients suffering from insulin-treated diabetes mellitus. To shed more light on this problem we performed a retrospective analysis of 40 patients with insulin-treated diabetes mellitus (three type-1; 37 type-2: insulin-treated for at least three months before cardiac transplantation) referred to our transplant unit for cardiac transplantation between March 1989 and December 1996.
Results:
Orthotopic cardiac transplantation was performed in 40 patients (4 women, 36 men) aged 32-73 years (mean 56 years) with an insulin-treated diabetes mellitus preexisting for 3-348 months (mean 65.1 months). Donor age ranged from 15 to 72 years (mean 35.5 years) matched for body weight and blood group. Overall mortality in this group was 40.0% with an early mortality of 12.5%.
Conclusions:
Our results show that type-1/2 insulin-treated diabetes mellitus preoperative to heart transplantation is not a contraindication in patients suffering from end-stage heart failure. Adequate therapy of diabetes mellitus as well as individual immunosuppressive therapy are important in order to minimize additional organ damage caused by the drugs themselves or resulting infectious complications.