New-Onset Diabetes Mellitus After Heart Transplantation　- Incidence, Risk Factors and Impact on Clinical Outcome.
New-onset diabetes mellitus (DM) can occur as a serious complication after heart transplantation, but the comparative data on its clinical impact on survival and on transplant-related adverse events are limited.



We reviewed a total of consecutive 391 patients aged ≥17 years undergoing isolated orthotopic heart transplantation at the present institution from 1992 to 2013. The entire cohort was divided into 3 groups: (1) no diabetes (n=257); (2) pre-existing DM (n=46); and (3) new-onset DM (n=88). Early and long-term clinical outcomes were compared across the 3 groups. Early death occurred in 8 patients (2.0%). Of the 345 non-diabetic patients before transplantation, 88 (25.5%) developed new-onset DM postoperatively. During follow-up, 83 (21.2%) died. On time-varying Cox analysis, new-onset DM was associated with increased risk for overall death (HR, 2.11; 95% CI: 1.26-3.55) and tended to have a greater risk for severe chronic kidney disease (HR, 1.77; 95% CI: 0.94-3.44). Compared with the no-diabetes group, the new-onset DM group had a worse survival rate (P=0.035), but a similar survival rate to that of the pre-existing DM group (P=0.364).



New-onset DM has a negative effect on long-term survival and kidney function after heart transplantation. Further studies are warranted to evaluate the relevance of early diagnosis and timely control of new-onset DM to improve long-term survival.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Ho Jin
HJ
Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Sung-Ho
SH
Jung
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine.
Jae-Joong
JJ
Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Tae-Jin
TJ
Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Joon Bum
JB
Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Suk Jung
SJ
Choo
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Cheol Hyun
CH
Chung
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Jae Won
JW
Lee
D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000209:etiology* / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
Heart transplantation; New-onset diabetes mellitus; Risk factor; Survival