Morbidity and mortality in diabetic patients following cardiac transplantation.
BACKGROUND
Diabetes remains a relative contraindication to cardiac transplantation. Previous reports have described small numbers of diabetic patients without end-organ damage who have undergone successful cardiac transplantation.


METHODS
A retrospective analysis of diabetic patients transplanted and their outcome in a single large center from 1/1/95 to 12/31/99 was performed. Diabetes was defined as "medium risk" by the presence of any of the following parameters: duration of therapy >10 years; use of insulin; serum creatinine >2 mg/dl; urinary protein >300 mg per 24 hours; presence of peripheral vascular disease (ankle:brachial ratio <1.0); and documentation of other diabetic comorbidity (retinopathy, neuropathy, gastroparesis).


RESULTS
During this time period, 374 adult cardiac transplants were performed. Seventy-six patients (20%) were diabetic with 33 patients (43%) requiring insulin. Forty-two of the patients had moderate disease. Survival of the diabetic and non-diabetic recipients was comparable (1- and 3-year survival of 86% and 85%. vs 87% and 84%, respectively, p = NS). No difference in survival between "medium-risk" and "low-risk" diabetics was observed. The incidence of acute rejection in the first year, graft vasculopathy and infection, was comparable between diabetic and non-diabetic patients. In both diabetic and non-diabetic patients, there was a similar and small insignificant increase in serum creatinine.


CONCLUSIONS
More patients with advanced diabetes are undergoing cardiac transplantation and the early and mid-term survival remains comparable to non-diabetic recipients. Future liberalization of transplantation in diabetics appears likely.
Lang
Chim C
CC
Columbia Presbyterian Medical Center, New York, New York 10032, USA.
Beniaminovitz
Ainat
A
Edwards
Niloo
N
Mancini
Donna M
DM
D016022:Case-Control Studies; D000075202:Contraindications; D048909:Diabetes Complications; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome