title: Diabetes as an outcome predictor after heart transplantation.
abstract: We aimed to compare post-transplantation morbidity and survival among heart transplant recipients with and without diabetes mellitus. A retrospective review of 141 adult patients submitted to heart transplantation from November 2003 to June 2009 (with a minimum follow-up of one year) was undertaken. The patients were divided into two groups: those with (29%) and those without (71%) pre-transplantation diabetes. Those with diabetes were older (57.6 ± 6.1 vs. 52.3 ± 11.1 years; P=0.020) and had lower creatinine clearance (53.6 ± 15.1 vs. 63.7 ± 22.1; P=0.029). Nine patients died in hospital (6.4%; P=non-significant). No significant differences in lipid profiles (diabetes vs. no diabetes) existed before transplantation or at one year afterwards. Patients with diabetes showed a significant deterioration in their one-year lipid profile (158 ± 43 vs.192 ± 38 mg/dl; P=0.001), although one-year fasting diabetic was lower than before (178 ± 80 vs. 138 ± 45 mg/dl; P=0.016). During the first year, 17 (17%) patients previously free of diabetes developed new-onset diabetes. No significant differences were seen in rejection at one year (14% vs. 20%), infection (31% vs. 33%), new-onset renal dysfunction (8% vs. 14%) or mortality (17% vs. 7%). One-year survival was not significantly different (83% vs. 94%), but there was a significant decrease in the survival of individuals with diabetes at three years (73% vs. 91%; P=0.020). No significant difference was found in one-year survival or in terms of higher morbidity in the heart transplant patients with diabetes, but a longer follow-up showed a significant decrease in survival. Nonetheless, the patients with diabetes benefited significantly from transplantation and should not be excluded from it.
authors.affiliation: Department of Cardiothoracic Surgery and Thoracic Organ Transplantation, University Hospitals and Faculty of Medicine, Coimbra,  Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Saraiva
authors.forename: Emília
authors.initials: E
authors.lastname: Sola
authors.forename: David
authors.initials: D
authors.lastname: Prieto
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Antunes
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D018579:Patient Selection; D011174:Portugal; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D008055:Lipids; D014527:Uric Acid