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Published on: July 23, 2017
Heart transplantation in patients with diabetes mellitus in the current era
Daniel Marelli1, Hillel Laks, Bijal Patel
1Heart Transplant Program, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. dmarelli@kumc.edu
Insights
Patients with diabetes mellitus (DM) face increased infection risks after heart transplantation, especially early post-surgery. Obesity and renal function are key factors for candidacy evaluation in these individuals.
Area of Science:
- Cardiology
- Transplantation Medicine
- Endocrinology
Background:
- Heart transplantation outcomes in patients with diabetes mellitus (DM) require thorough investigation.
- Understanding the specific risks associated with DM in cardiac transplant recipients is crucial for improving patient care.
Purpose of the Study:
- To examine the risks of heart transplantation in patients with diabetes mellitus (DM).
- To compare outcomes between heart transplant recipients with and without DM.
Main Methods:
- A single-institution database was used to review recipients aged 18+ who underwent cardiac transplantation between July 1994 and December 2000.
- 101 patients with DM were compared to 244 patients without DM, analyzing survival, renal function, transplant coronary artery disease (TCAD), rejection, and infection rates.
Main Results:
- Patients with DM had higher BMIs and a higher prevalence of ischemic cardiomyopathy.
- An increased risk of serious infections was observed in the DM group, particularly within the first three months post-transplant.
- While 5-year survival was similar, multivariate analysis identified baseline creatinine and obesity (BMI >30) as significant risk factors for survival in DM patients.
Conclusions:
- Patients with diabetes mellitus experience a higher risk of severe infections following heart transplantation, especially in the early postoperative phase.
- Careful evaluation of obesity and renal function is essential when considering cardiac transplant candidacy for patients with DM.
Background:
In this study, we used a single-institution database to examine the risks of heart transplantation in patients with diabetes mellitus (DM).
Methods:
Recipients 18 years and older who underwent cardiac transplantation from July 1994 to December 2000 were reviewed; 101 consecutive patients with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were compared with 244 patients who did not have DM and who received standard donor hearts. Survival, renal function (serum creatinine concentration), development of transplant coronary artery disease (TCAD), severe rejection, and infection (requiring hospitalization) were analyzed.
Results:
Patients with DM were older (mean age, 57.1 years vs 51.4 years), had greater body mass index (mean, 26.7 vs 24.1 kg/m(2), p < 0.02), and more commonly had ischemic cardiomyopathy (58% vs 43%, p = 0.02). We found a trend toward decreased survival for those with DM at 1 year (85.1% vs 90.9%; p = 0.12). Five-year survival was 81.6% for both groups. Mean follow-up time was 4.1 years. Infection rate within 3 months was greater among those with DM (14% vs 3%, odds ration = 5.09; 95% confidence interval, 1.59-16.23). Freedom from infection at 4 years was 71.0% for patients with DM and 85.0% for those without DM (p = 0.02). Freedom from rejection at 4 years was similar (70.6% vs 73.6%, p = 0.69). At 4 years, transplant coronary artery disease (TCAD)-free survival was 69.5% for those with DM and 81.6% for those without (p = 0.23). Mean serum creatinine concentration at 4 years after transplant was 1.5 mg/dl in patients with DM (vs 1.4, p = 0.28). Multivariate analysis showed increased baseline creatinine level as a significant risk factor for survival and showed pre-transplant ischemic cardiomyopathy as a risk factor for TCAD in both groups. Body mass index >30 was a significant risk factor for survival among patients with DM.
Conclusion:
We found an increased risk of serious infections in patients with DM, particularly in the early post-operative period. Careful consideration of obesity and renal function during evaluation of candidacy is indicated.
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