Impact of diabetes mellitus on survival rates after heart transplantation.
OBJECTIVE
Heart transplantation (HTx) is the most effective therapy in patients with end-stage heart failure. Diabetes-related complications are relative contraindications for heart transplantation. The aim of our study was to analyse the impact of DM (diabetes mellitus) at the time of heart transplantation and new-onset post-transplantation DM on long-term survival.


METHODS
A retrospective database analysis was performed on all patients who had undergone HTx at our institution between 4/1997 and 9/2007. Patients were divided into three groups: Group A--patients without DM; Group B--patients with new onset of DM after HTx; Group C--patients with DM prior to HTx.


RESULTS
Patients with DM before the surgery were more obese, their BMI was 27.7 +/- 2.90, compared to groups A and B with BMI of 24.7 +/- 3.37 and 25.3 +/- 3.64 respectively (p = 0.0003). Patients in group B had statistically significantly higher risk of developing acute rejection (G 1B and more according to International Society of Heart and Lung Transplantation--ISHLT--classification) (p = 0.0350). The incidence of infections between individual groups showed no statistically significant differences (p = 0.5839). Five-year survival in group A was 82%, 10-year survival was 73%. Corresponding numbers for group B were 86% and 78%, for group C 86% and 83%. Differences between groups were not statistically significant (p = 0.2560).


CONCLUSIONS
DM in patients after heart transplantation in our study had no effect on long-term survival of patients. Post-transplantation DM increases risk of acute rejections. Pre-transplantation DM was associated with excessive bodyweight or obesity.
Bedanova
Helena
H
Center of Cardiovascular and Transplant Surgery, Pekarska 53, Brno, Czech Republic.
Ondrasek
Jiri
J
Cerny
Jan
J
Orban
Marek
M
Spinarova
Lenka
L
Hude
Petr
P
Krejci
Jan
J
Nemec
Petr
P
D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications; D015996:Survival Rate
D007166:Immunosuppressive Agents