Heart transplantation in patients with diabetes mellitus in the current era.
BACKGROUND
In this study, we used a single-institution database to examine the risks of heart transplantation in patients with diabetes mellitus (DM).


METHODS
Recipients 18 years and older who underwent cardiac transplantation from July 1994 to December 2000 were reviewed; 101 consecutive patients with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were compared with 244 patients who did not have DM and who received standard donor hearts. Survival, renal function (serum creatinine concentration), development of transplant coronary artery disease (TCAD), severe rejection, and infection (requiring hospitalization) were analyzed.


RESULTS
Patients with DM were older (mean age, 57.1 years vs 51.4 years), had greater body mass index (mean, 26.7 vs 24.1 kg/m(2), p < 0.02), and more commonly had ischemic cardiomyopathy (58% vs 43%, p = 0.02). We found a trend toward decreased survival for those with DM at 1 year (85.1% vs 90.9%; p = 0.12). Five-year survival was 81.6% for both groups. Mean follow-up time was 4.1 years. Infection rate within 3 months was greater among those with DM (14% vs 3%, odds ration = 5.09; 95% confidence interval, 1.59-16.23). Freedom from infection at 4 years was 71.0% for patients with DM and 85.0% for those without DM (p = 0.02). Freedom from rejection at 4 years was similar (70.6% vs 73.6%, p = 0.69). At 4 years, transplant coronary artery disease (TCAD)-free survival was 69.5% for those with DM and 81.6% for those without (p = 0.23). Mean serum creatinine concentration at 4 years after transplant was 1.5 mg/dl in patients with DM (vs 1.4, p = 0.28). Multivariate analysis showed increased baseline creatinine level as a significant risk factor for survival and showed pre-transplant ischemic cardiomyopathy as a risk factor for TCAD in both groups. Body mass index >30 was a significant risk factor for survival among patients with DM.


CONCLUSIONS
We found an increased risk of serious infections in patients with DM, particularly in the early post-operative period. Careful consideration of obesity and renal function during evaluation of candidacy is indicated.
Marelli
Daniel
D
Heart Transplant Program, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. dmarelli@kumc.edu
Laks
Hillel
H
Patel
Bijal
B
Kermani
Reza
R
Marmureanu
Alexander
A
Patel
Jignesh
J
Kobashigawa
Jon
J
D015992:Body Mass Index; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000453:epidemiology; D016208:Databases, Factual / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology*; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy; D007239:Infections / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012044:Regression Analysis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors