Predicting the occurrence of diabetes mellitus in recipients of heart transplants.
OBJECTIVE
To establish the incidence of post-transplant diabetes mellitus (PTDM) and factors predictive of its development.


METHODS
This was a retrospective review (using hospital records and transplant database) of 97 consecutive adult patients who underwent cardiac transplantation at St Vincent's Hospital, Sydney, Australia.


RESULTS
Mean follow-up was 27 months. Excluding five patients who had pre-existing diabetes, the cumulative incidence of PTDM was 15.7%. Pre-transplant random blood glucose (5.6 +/- 0.8 vs. 5.2 +/- 0.6 mmol/l, P<0.05), family history (46% vs. 15%, P<0.05) and a continuing requirement for insulin on the second post-transplant day (54% vs. 15%, P< 0.01) differed in those who developed PTDM as opposed to those who remained free of diabetes. Patients who developed PTDM had received slightly higher mean doses of prednisolone at three months (0.21 +/- 0.03 vs. 0.19 +/- 0.03 mg. kg(-1)/day(-1), P<0.01). Of the factors identifiable prior to initial hospital discharge, only family history of diabetes mellitus and second post-transplant day insulin requirement independently predicted the occurrence of PTDM.


CONCLUSIONS
A family history of diabetes and the need for insulin beyond the first 24 h after transplantation are factors identifiable prior to hospital discharge, which predict patients at risk of developing PTDM. In such patients, consideration to minimizing the dose of glucocorticoids should be given where possible.
Depczynski
B
B
Diabetes Centre, St Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia. b.depczynski@garvan.unsw.edu.au
Daly
B
B
Campbell
L V
LV
Chisholm
D J
DJ
Keogh
A
A
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D019992:Databases as Topic; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006753:Hospital Records; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors
D001786:Blood Glucose