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Elevated donor hemoglobin A1c does not impair early survival in cardiac transplant recipients
Jeremy T Joseph1, Michael S Mulvihill1, Babatunde A Yerokun1
1Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA.
Insights
Donor diabetes mellitus, indicated by high hemoglobin A1c (HbA1c) levels, did not impact heart transplant recipient survival. This suggests donor glycemic control alone is not a key predictor of long-term outcomes after orthotopic heart transplantation.
Area of Science:
- Cardiology
- Transplantation Immunology
- Endocrinology
Background:
- Orthotopic heart transplantation (OHT) is a critical treatment for end-stage heart failure.
- A significant gap exists between the need for heart allografts and their availability.
- The impact of donor diabetes mellitus on OHT recipient outcomes remains debated.
Purpose of the Study:
- To investigate the effect of donor glycemic control, assessed by hemoglobin A1c (HbA1c), on recipient survival after OHT.
- To determine if donor hyperglycemia influences post-transplant outcomes.
Main Methods:
- Analysis of adult OHT recipients from the UNOS database (2010-2015).
- Stratification into hyperglycemic (HbA1c ≥6.5%) and euglycemic (HbA1c <6.5%) donor groups.
- Comparison of three-year survival rates using propensity matching.
Main Results:
- 3.89% of recipients received allografts from hyperglycemic donors.
- No significant difference in three-year survival was observed between recipients of hyperglycemic and euglycemic donor allografts, even after propensity matching (P=.87 and P=.78).
Conclusions:
- Donor hyperglycemia, based on HbA1c levels, did not adversely affect four-year recipient survival after OHT.
- These findings indicate that donor glycemic status alone may not be a critical determinant of OHT recipient outcomes.
Background:
Orthotopic heart transplantation (OHT) is the gold-standard therapy for end-stage heart failure. An increasing deficit between suitable allograft availability and clinical demand for OHT exists. The role of donor diabetes mellitus (DM) on post-transplant recipient outcomes in OHT is controversial. The purpose of this study was to examine donor hemoglobin A1c (HbA1c) levels to identify the impact of donor glycemic control on recipient survival.
Methods:
Adult OHT recipients with donor HbA1c data were identified in the UNOS database from 2010 to 2015. Recipients were stratified on the basis of donor glycemic status: Hyperglycemic-donor and euglycemic-donor cohorts were defined as HbA1c levels ≥6.5% and <6.5%, respectively. Outcomes were compared between unadjusted and propensity-matched hyperglycemic versus euglycemic donors. Primary end point was three-year survival.
Results:
Of 5342 OHT recipients, 208 (3.89%) received an allograft from a hyperglycemic donor and 5134 (96.1%) received an allograft from a euglycemic donor. There was no significant difference in survival in the hyperglycemic group before (P=.87) or after (P=.78) propensity matching.
Conclusions:
No difference in four-year survival was noted in recipients who received allografts from hyperglycemic donors. These results suggest that recent cumulative donor glycemic status alone may not be an important predictor of recipient outcomes.
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