Predictability and other aspects of post-transplant diabetes mellitus in heart transplant recipients.
BACKGROUND
Diabetes mellitus that develops after organ transplantation may predispose patients to further complications. We studied the value of pre-transplant oral glucose tolerance testing or maximum random plasma glucose, and HLA-DR3 and/or DR4 phenotype as predictors of post-transplantation diabetes mellitus in heart transplant recipients.


METHODS
In 228 cardiac allograft recipients (median age, 50 years; mean follow-up, 4.77 years), we used either pre-transplant oral glucose tolerance testing results (Group I, n = 141)-excluding patients with pre-existing diabetes (n = 9)--or maximum random plasma glucose values (Group II, n = 78) to study predictability of post-transplant diabetes. In addition, we investigated its relation to rejection treatment and clinical course.


RESULTS
Cumulative incidence of post-transplant diabetes (n = 43) was 19.6%, 83% of which became manifest within 3 months post-transplant; pre-transplant body mass index was higher (p < 0.01) in this group. Mortality did not increase. Of 123 patients in Group I who survived > 3 months, post-transplant diabetes occurred in 32% vs 16% of those with impaired and normal glucose tolerance respectively (ns), and in 55% of patients with isolated post-load hyperglycemia (p < 0.05 vs normal). Maximum random glucose values (Group II) did not predict post-transplant diabetes. Prevalence of the HLA-DR3, DR4, and DR3DR4 phenotypes did not increase in post-transplant diabetes; relation to rejection treatment was likely in 30%. Approximately 50% of posttransplant diabetes patients required only temporary drug treatment.


CONCLUSIONS
The risk of post-transplant diabetes increased parallel to pre-transplant degree of glucose intolerance, but was considerable even in normal glucose tolerance. HLA-DR3 and/or DR4 phenotype was not a predisposing factor.
Nieuwenhuis
M G
MG
Department of Internal Medicine, Utrecht, The Netherlands. M.G.Nieuwenhuis@digd.azu.nl
Kirkels
J H
JH
D000328:Adult; D017668:Age of Onset; D000368:Aged; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D015803:HLA-DR3 Antigen / Q000235:genetics; D015804:HLA-DR4 Antigen / Q000235:genetics; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007328:Insulin / Q000627:therapeutic use; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010641:Phenotype; D011237:Predictive Value of Tests; D012307:Risk Factors; D015996:Survival Rate
D001786:Blood Glucose; D015803:HLA-DR3 Antigen; D015804:HLA-DR4 Antigen; D007166:Immunosuppressive Agents; D007328:Insulin