title: Impact of pre-operative diabetes mellitus upon early and late survival after heart transplantation: a possible era effect.
abstract: BACKGROUND
  The effect of pre- or post-operatively acquired diabetes mellitus on survival after heart transplantation remains controversial. The influence of transplant era on diabetes-associated survival is unknown.
  
  
  METHODS
  A retrospective database analysis was performed on all cardiac transplant recipients followed up at our institution between 1986 and 2003. Diabetes mellitus was diagnosed based on oral glucose tolerance testing.
  
  
  RESULTS
  Survival was analyzed in 243 patients (80% male, mean age 52.2 years, mean follow-up 5.22 years). Kaplan-Meier survival analysis demonstrated significantly worse (p = 0.0001) survival both early (months 0 to 12) and late (>5 years) after transplantation in pre-operative diabetics (n = 53) compared with non-diabetics (n = 190). Pre-operative diabetes was identified as the only independent risk factor for decreased long-term (>1 year) survival (p = 0.004). In contrast, no effect on survival (p = 0.5) was demonstrated in patients becoming diabetic only after heart transplantation (n = 39). At 12 months post-transplant renal function was significantly impaired in diabetics (p = 0.025); acute rejection, cytomegalovirus (CMV) infection and transplant vasculopathy occurred with similar frequency. Causes of death were similar in diabetics and non-diabetics. Reduced long-term survival in pre-operative diabetics was seen in the early transplant era (1986 to 1994) (p < 0.0001), but not in the more recent era (1995 to 2003) (p = 0.5).
  
  
  CONCLUSIONS
  Pre-transplant but not post-transplant diabetes confers an adverse risk for survival (short and long term). Diabetes-associated long-term survival appears to have improved in the recent era, supporting continued transplantation in diabetics under close surveillance and aggressive medical management.
authors.affiliation: Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Klingenberg
authors.forename: Christian
authors.initials: C
authors.lastname: Gleissner
authors.forename: Achim
authors.initials: A
authors.lastname: Koch
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Schnabel
authors.forename: Falk-Udo
authors.initials: FU
authors.lastname: Sack
authors.forename: Rainer
authors.initials: R
authors.lastname: Zimmermann
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Dengler
mesh_terms: D001706:Biopsy; D002423:Cause of Death; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006084:Graft Rejection / Q000473:pathology; D016027:Heart Transplantation / Q000401:mortality* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis