[Impact of diabetes mellitus on heart transplant recipients].
OBJECTIVE
At present, there is some controversy about the impact of diabetes mellitus on heart transplant patients. The effect of the disease on mortality and on other complications, such as infection or rejection, is unclear. The objective of this study was to investigate these factors in our heart transplant patients.


METHODS
We studied 365 consecutive patients who underwent heart transplantation between November 1987 and May 2003. We divided them in three groups according to whether they had pretransplantation diabetes (group 1), de novo diabetes (group 2), or no diabetes (group 3). Baseline variables and the development of complications were recorded, and findings were analyzed using Student's t test, chi squared test, and Kaplan-Meier survival analysis.


RESULTS
There was no difference in the 1-year or 5-year survival rate between the groups (P=.24 and P=.32, respectively). Patients with pretransplantation and de novo diabetes were older (54.6 years vs 54.9 years vs 50.6 years, P=.04), had a higher prevalence of hypertension (48% vs 36% vs 23%, P=.001), and had more frequently been treated with tacrolimus (10% vs 12% vs 4%, P=.04) or steroids (92% vs 86% vs 70%, P=.001). The incidence of rejection during follow-up was greater in these two groups (64% vs 70% vs 45%, P=.001).


CONCLUSIONS
Neither pretransplantation diabetes nor de novo diabetes had a negative impact on survival in our heart transplant patients. The disease's presence was associated with treatment with steroids and tacrolimus. In these patients it would be preferable to individualize immunosuppressive therapy.
Moro
José A
JA
Servicio de Cardiología, Hospital Universitario La Fe, Valencia, Spain. moro@uv.es
Martínez-Dolz
Luis
L
Almenar
Luis
L
Martínez-Ortiz
Luis
L
Chamorro
Carlos
C
García
Carlos
C
Arnau
Miguel A
MA
Rueda
Joaquín
J
Zorio
Esther
E
Salvador
Antonio
A
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016559:Tacrolimus