The impact of diabetes mellitus at the time of heart transplantation on long-term survival

• Published in: Diabetologia Vol. 45; no. 11; pp. 1498 - 1508
• Main Authors: CZERNY, M, SAHIN, V, FASCHING, P, ZUCKERMANN, A, ZIMPFER, D, KILO, J, WOLNER, E, GRIMM, M
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-11-2002; Springer Nature B.V
• Subjects: Adult; Associated diseases and complications; Austria - epidemiology; Biological and medical sciences; Cardiomyopathy; Cardiovascular disease; Coronary Angiography; Coronary Disease - diagnostic imaging; Coronary Disease - surgery; Coronary vessels; Creatinine; Cytomegalovirus; Diabetes; Diabetes Mellitus - blood; Diabetes Mellitus - epidemiology; Diabetes Mellitus - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - surgery; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Follow-Up Studies; Glycated Hemoglobin A - analysis; Heart Transplantation - physiology; Heart Transplantation - statistics & numerical data; Heart transplants; Humans; Induction therapy; Intraoperative Complications - mortality; Ischemia; Male; Medical prognosis; Medical sciences; Middle Aged; Proportional Hazards Models; Reoperation - statistics & numerical data; Retrospective Studies; Risk Factors; Steroids; Survivors; Thoracic surgery; Time Factors; Ultrasonic imaging; Vein & artery diseases; Germany; Endocrinopathy; Heart; Human; heart transplantation; Diabetes mellitus; Cardiovascular disease; Transplantation; Circulatory system; transplant coronary artery disease; Coronary heart disease; Long term; Survival
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-002-0960-0

To analyse the impact of diabetes mellitus (DM) at the time of heart transplantation on long-term survival and incidence of transplant coronary artery disease (TxCAD).
We analysed 773 consecutive adult heart transplant recipients who underwent primary heart transplantation from May 1986 until December 2000. The cohort consisted of 140 patients with diabetes mellitus (with DM, men 82%) and 633 patients without (wo DM, men 84%) diabetes mellitus at the time of transplantation. The patients were documented as to survival and incidence of TxCAD.
Patients with diabetes mellitus were older compared to those without diabetes mellitus (with DM 54.9+/-6.8a vs wo DM 49.7+/-10.8a; p=0.0001), they had a higher incidence of ischaemic cardiomyopathy prior to transplantation (with DM 52% vs wo DM 30%; p=0.0001), but reduced long-term survival (10 year survival: with DM 40% vs wo DM 58%; log-rank=0.025). Surprisingly, the incidence of transplant coronary artery disease (TxCAD) was comparable at 10 years (with DM 28% vs wo DM 22%; log-rank=0.625). In multivariate Cox proportional hazard analysis, diabetes mellitus present at the time of heart transplantation (HR 1.594; 95%CI 1.009-2.518; p=0.045), but not age (HR 0.990; 95%CI 0.965-1.014; p=0.404) was an independent predictor affecting long-term survival.
The presence of diabetes mellitus at the time of heart transplantation adversely affects long-term patient survival, but does not predict the occurrence of transplant coronary artery disease. The definite mechanisms of adverse survival primarily seem to relate to generally impaired global organ function. Despite a less favourable long-term outcome, our data still justify heart transplantation in end-stage heart failure patients with diabetes mellitus.