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Long-term results in diabetic patients undergoing heart transplantation
E Munoz1, J L Lonquist, B Radovancevic
1Department of Cardiac and Cardiopulmonary Transplantation, Texas Heart Institute/St. Luke's Episcopal Hospital, Houston.
Insights
Diabetic patients undergoing heart transplantation show similar long-term survival rates to nondiabetic patients. This study indicates heart transplantation is feasible in selected diabetic recipients, with no increased risk of rejection or infection.
Area of Science:
- Cardiology
- Transplantation Medicine
- Endocrinology
Background:
- Heart transplantation is a life-saving procedure for end-stage heart failure.
- The impact of diabetes mellitus on long-term outcomes after heart transplantation requires further investigation.
Purpose of the Study:
- To compare the long-term survival and complication rates of heart transplantation in diabetic versus nondiabetic patients.
- To assess the feasibility of heart transplantation in selected diabetic recipients.
Main Methods:
- A retrospective study analyzing 305 nondiabetic and 37 diabetic patients who underwent heart transplantation between July 1982 and May 1990.
- Actuarial survival analysis was performed at 1 and 2 years post-transplantation.
- Long-term outcomes (mean follow-up 31.8-32.9 months) were analyzed for patients surviving over 1 year, focusing on rejection rates, infection rates, renal function, and coronary artery disease development.
Main Results:
- Actuarial survival at 1 and 2 years was similar between diabetic and nondiabetic groups.
- No significant differences were found in rejection rates, infection rates, or renal function (mean creatinine levels) between the groups.
- Coronary artery disease incidence by year four was comparable (32.8% nondiabetic vs. 31.0% diabetic).
- Insulin-dependent diabetic patients required a 2.12-fold increase in insulin dose one year post-transplantation.
Conclusions:
- Diabetic patients experience similar long-term survival after heart transplantation compared to nondiabetic patients.
- Heart transplantation is a viable option for selected diabetic patients, with no increased risk of major complications.
- Careful patient selection and management are crucial for successful outcomes in diabetic heart transplant recipients.
Abstract:
We conducted a retrospective study of 305 nondiabetic patients and 37 diabetic patients who underwent heart transplantation from July 1982 to May 1990. Actuarial survival was similar for both groups of patients at 1 year (76.4% versus 81.3%) and at 2 years (69.6% versus 73.0%). Because we were interested in long-term results, we further analyzed only those patients surviving more than 1 year after transplantation (214 nondiabetic patients and 29 diabetic patients). Mean follow-up for the nondiabetic patients was 31.8 +/- 16.2 months and for the diabetic patients, 32.9 +/- 4.1 months. The respective mean age in each group was 50.4 +/- 10.3 years and 51.6 +/- 9.1 years. No difference was observed between the nondiabetic patients and diabetic patients regarding the rejection rate per patient-month (0.040 +/- 0.041 versus 0.045 +/- 0.051 episodes per patient-month), the infection rate per patient-month (0.056 +/- 0.081 versus 0.081 +/- 0.102 episodes per patient-month), or renal function as evidenced by mean creatinine levels at 1, 2, and 3 years. Twelve patients were insulin-dependent before transplantation; and 1 year after transplantation, they required an insulin dose 2.12 times greater than the dose before operation. Coronary artery disease developed in 32.8% of the nondiabetic patients, compared with 31.0% of the diabetic patients by the fourth year of follow-up. Despite the need for increased insulin doses, the diabetic patients had similar long-term survival to that of the nondiabetic patients, without an increased risk of rejection, infection, renal dysfunction, or coronary artery disease. Our experience supports the feasibility of heart transplantation in selected diabetic recipients.