title: Cardiac transplantation can be safely performed using selected diabetic donors.
abstract: OBJECTIVE
  Cardiac transplantation (OHT) using diabetic donors (DDs) is thought to adversely influence survival. We attempt to determine if adult OHT can be safely performed using selected DDs.
  
  
  METHODS
  The United Network for Organ Sharing (UNOS) database was examined for adult OHT from 2000 to 2010.
  
  
  RESULTS
  Of the 20,348 patients undergoing OHT, 496 (2.4%) were with DDs. DDs were older (39.6 vs 31.3 years; P < .001), more likely female (41.5% vs 28.3%; P < .001), and had a higher body mass index (BMI) (29.9 vs 26.4; P < .001). Recipients of DD hearts were older (53.4 vs 51.8; P = .004) and more likely to have diabetes (18.9% vs 14.9%; P = .024). The 2 groups were evenly matched with regard to recipient male gender (78.0% vs 76.1%; P = .312), ischemic time (3.3 vs 3.2 hours; P = .191), human leukocyte antigen mismatches (4.7 vs 4.6; P = .483), and requirement of extracorporeal membrane oxygenation (ECMO) as a bridge to transplant (0.8% vs 0.5%; P = .382). Median survival was similar (3799 vs 3798 days; P = .172). On multivariate analysis, DD was not associated with mortality (hazard ratio [HR], 1.155; 95% confidence interval [CI], 0.943-1.415; P = .164). As previously demonstrated, donor age, decreasing donor BMI, ischemic time, recipient creatinine, recipient black race, recipient diabetes, race mismatch, and mechanical ventilation or ECMO as a bridge to transplant were associated with mortality. On multivariate analysis of subgroups, neither insulin-dependent diabetes (1.173; 95% CI, 0.884-1.444; P = .268) nor duration of diabetes for more than 5 years (HR, 1.239; 95% CI, 0.914-1.016; P = .167) was associated with mortality.
  
  
  CONCLUSIONS
  OHT can be safely performed using selected DDs. Consensus criteria for acceptable cardiac donors can likely be revised to include selected DDs.
authors.affiliation: Department of Surgery, Temple University Hospital, Philadelphia, Pa, USA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Wilson
authors.forename: Eugene
authors.initials: E
authors.lastname: Komaroff
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
authors.forename: Abeel A
authors.initials: AA
authors.lastname: Mangi
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D046148:Donor Selection; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: 34; BMI; CI; ECMO; HR; UNOS; United Network for Organ Sharing; body mass index; confidence interval; extracorporeal membrane oxygenation; hazard ratio