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Diabetes and heart transplantation
M J Rhenman1, B Rhenman, T Icenogle
1Department of Surgery, University of Arizona Health Sciences Center, Tucson 85724.
Insights
Selected patients with diabetes mellitus can undergo successful heart transplantation. This study found no significant difference in survival rates between diabetic and nondiabetic heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Endocrinology
Background:
- Diabetes mellitus has historically been considered a contraindication for heart transplantation.
- Assessing the outcomes of heart transplantation in diabetic patients is crucial for expanding eligibility criteria.
Purpose of the Study:
- To evaluate the survival rates and post-transplant complications in patients with diabetes mellitus undergoing heart transplantation.
- To determine if diabetes mellitus is a significant contraindication for heart transplantation.
Main Methods:
- A retrospective comparison of 9 diabetic patients and 57 nondiabetic patients who underwent heart transplantation between June 1985 and December 1987.
- Analysis of actuarial survival, rejection episodes, and infection rates in both groups.
- Standard immunosuppression protocols including cyclosporine, azathioprine, and prednisone were used.
Main Results:
- Actuarial survival rates were 100% for diabetic patients and 97.7% for nondiabetic patients at the study's end.
- No significant difference in survival was observed between the two groups.
- Diabetic patients showed a trend towards more frequent rejection episodes and fewer infections.
Conclusions:
- Diabetes mellitus is not an absolute contraindication for heart transplantation in selected patients.
- Successful outcomes are achievable in diabetic heart transplant recipients, with survival comparable to nondiabetic patients.
- Careful patient selection and management are essential for optimizing results in diabetic heart transplant candidates.
Abstract:
Diabetes mellitus remains a relative contraindication to heart transplantation. From June 1985 to December 1987, 71 patients underwent heart transplantation. Fifty-seven patients were nondiabetic, and nine had preexisting diabetes mellitus. Four patients were insulin dependent and three were not. All operative survivors (66) from these two groups were compared for survival and numbers of rejection and infection. Actuarial survival in the group with diabetes mellitus was 100% and 97.7% in the group without diabetes. Immunosuppression was maintained with cyclosporine, azathioprine, and low-dosage prednisone. In the group with diabetes two patients were maintained without prednisone. Selected diabetic patients can have successful transplantations. There is no significant difference in survival between the diabetic and nondiabetic patient. There is a tendency toward more rejections and fewer infections among the diabetic patients. In our experience diabetes mellitus is not a contraindication to heart transplantation.