Morbidity and mortality in diabetic patients following cardiac transplantation

• Published in: The Journal of heart and lung transplantation Vol. 22; no. 3; pp. 244 - 249
• Main Authors: Lang, Chim C, Beniaminovitz, Ainat, Edwards, Niloo, Mancini, Donna M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2003; Elsevier Science
• Subjects: Biological and medical sciences; Case-Control Studies; Contraindications; Diabetes Complications; Female; Graft Rejection - epidemiology; Heart Transplantation - mortality; Humans; Incidence; Male; Medical sciences; Middle Aged; Morbidity; Postoperative Complications - epidemiology; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Treatment Outcome; Endocrinopathy; Kidney disease; Heart; Human; Graft(material); Urinary system disease; Prognosis; Diabetes mellitus; Mortality; Cardiovascular disease; Transplantation; Homotransplantation; Morbidity; Infection; Rejection; Vascular disease; Concomitant disease; Surgery; Renal failure; Complication; Comparative study
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/S1053-2498(02)00567-3

Diabetes remains a relative contraindication to cardiac transplantation. Previous reports have described small numbers of diabetic patients without end-organ damage who have undergone successful cardiac transplantation. A retrospective analysis of diabetic patients transplanted and their outcome in a single large center from 1/1/95 to 12/31/99 was performed. Diabetes was defined as “medium risk” by the presence of any of the following parameters: duration of therapy >10 years; use of insulin; serum creatinine >2 mg/dl; urinary protein >300 mg per 24 hours; presence of peripheral vascular disease (ankle:brachial ratio <1.0); and documentation of other diabetic comorbidity (retinopathy, neuropathy, gastroparesis). During this time period, 374 adult cardiac transplants were performed. Seventy-six patients (20%) were diabetic with 33 patients (43%) requiring insulin. Forty-two of the patients had moderate disease. Survival of the diabetic and non-diabetic recipients was comparable (1- and 3-year survival of 86% and 85%. vs 87% and 84%, respectively, p = NS). No difference in survival between “medium-risk” and “low-risk” diabetics was observed. The incidence of acute rejection in the first year, graft vasculopathy and infection, was comparable between diabetic and non-diabetic patients. In both diabetic and non-diabetic patients, there was a similar and small insignificant increase in serum creatinine. More patients with advanced diabetes are undergoing cardiac transplantation and the early and mid-term survival remains comparable to non-diabetic recipients. Future liberalization of transplantation in diabetics appears likely.