Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009, 153(4):283-287 | DOI: 10.5507/bp.2009.047

IMPACT OF DIABETES MELLITUS ON SURVIVAL RATES AFTER HEART TRANSPLANTATION

Helena Bedanovaa, Jiri Ondraseka, Jan Cernya, Marek Orbana, Lenka Spinarovab, Petr Hudeb, Jan Krejcib, Petr Nemeca
a Center of Cardiovascular and Transplant Surgery, Pekarska 53, Brno, Czech Republic
b Department of Cardio-Angiology, St. Anne University Hospital, Pekarska 53, Brno

Aims: Heart transplantation (HTx) is the most effective therapy in patients with end-stage heart failure. Diabetesrelated complications are relative contraindications for heart transplantation. The aim of our study was to analyse the impact of DM (diabetes mellitus) at the time of heart transplantation and new-onset post-transplantation DM on long-term survival.

Methods: A retrospective database analysis was performed on all patients who had undergone HTx at our institution between 4/1997 and 9/2007. Patients were divided into three groups: Group A - patients without DM; Group B - patients with new onset of DM after HTx; Group C - patients with DM prior to HTx.

Results: Patients with DM before the surgery were more obese, their BMI was 27.7 ± 2.90, compared to groups A and B with BMI of 24.7 ± 3.37 and 25.3 ± 3.64 respectively (p = 0.0003). Patients in group B had statistically significantly higher risk of developing acute rejection (G 1B and more according to International Society of Heart and Lung Transplantation - ISHLT - classification) (p = 0.0350). The incidence of infections between individual groups showed no statistically significant differences (p = 0.5839). Five-year survival in group A was 82%, 10-year survival was 73%. Corresponding numbers for group B were 86% and 78%, for group C 86% and 83%. Differences between groups were not statistically significant (p = 0.2560).

Conclusions: DM in patients after heart transplantation in our study had no effect on long-term survival of patients. Post-transplantation DM increases risk of acute rejections. Pre-transplantation DM was associated with excessive bodyweight or obesity.

Keywords: Heart transplantation, Diabetes mellitus, Survival analysis

Received: July 14, 2009; Accepted: October 30, 2009; Published: December 1, 2009  Show citation

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Bedanova, H., Ondrasek, J., Cerny, J., Orban, M., Spinarova, L., Hude, P., Krejci, J., & Nemec, P. (2009). IMPACT OF DIABETES MELLITUS ON SURVIVAL RATES AFTER HEART TRANSPLANTATION. Biomedical papers, 153(4), 283-287. doi: 10.5507/bp.2009.047
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    References

    1. Bangratz S. Complacations in heart transplantation: diagnosis and treatment. Presse Med 2001; 30(24):812.
    2. Morgan JA, John R, Weinberg AD, Colletti NJ, Mancini DM, Edwards NM. Heart transplantation in diabetic patients: a decade review of 161 patients at Columbia Presbyterian. J Thorac Cardiovasc Surg 2004; 127(5):148692. Go to original source... Go to PubMed...
    3. Higgins J, Pflugfelder PW, Kostuk WJ. Increased Morbidity in diabetic cardiac transplant recipients. Can J Cardiol 2009; 25(4):125 9. Go to original source... Go to PubMed...
    4. Starzl TE. Postoperative and surgical complications. In: Starzl TE Experience in renal transplantation. Philadelphia: Sauders; 1964:117.
    5. Jindal RM, Sidner RA, Milgrom ML. Post-transplant diabetes mellitus: the role of immunosuppression. Drug Saf. 1997; 16(4):24257. Go to original source... Go to PubMed...
    6. Durrbach A. Diabetes after transplantation. Nephrol Ther 2006; 5(3):S1979.
    7. Landowski JS, Kormos RL, Uretsky BF, Lee A, Curran M, Clark R, Armitage JM, Griffith BP, Hardesty RL. Posttransplantation diabetes mellitus in heart transplant recipients. J Heart Transplant 1989; 8:1819.
    8. Kaplan EL, Meier P. Nonparametric estimation from incomplete obsarvations. J Amer Statist Ass 1958; 53:45781. Go to original source...
    9. World Health Organisation Diabetes Database. Available at: http:// www.who.int/ncd/dia/databases4.htm. Accessed 28.January 2003.
    10. Baid S, Cosimi AB, Farrel ML, Schoenfeld DA, Feng S, Chung RT, Tolkoff-Rubin N, Pascual M. Posttransplant diabetes mellitus in liver transplant recipients: Risk factors, temporal relationship with hepatitis C virus allograft hepatitis, and impact on mortality. Transplantation 2001; 72(6):106672. Go to original source... Go to PubMed...
    11. Reddy KS, Stablein D, Taranto S, Stratta RJ, Johnston TD, Waid TH, McKeown JW, Lucas BA, Ranjan D. Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis 2003; 41(2):46470. Go to original source... Go to PubMed...
    12. Marchetti P. New-outset diabetes after transplantation. J Heart Lung Transplant. 2004; 2 3(S5):1942001. Go to original source... Go to PubMed...
    13. Bangratz S. Complications in heart transplantation: diagnosis and treatment. Presse Med. 2001; 20(24):812.
    14. Kobashigawa JA, Starling RC, Mehra MR, Kormos RL, Bhat G, Barr ML, Sigouin CS, Kolesar J, Fitzsimmons W. Multicenter retrospective analysis of cardiovascular risk factors affecting long-term outcomes of de novo cardiac transplant recipients. J Heart Lung transplant. 2006; 25(9):10639. Go to original source... Go to PubMed...
    15. Czerny M, Sahin V, Fasching P, Zuckermann A, Zimpfer D, Kilo J, Wolner E, Grimm M. The impact of diabetes mellitus at the time of heart transplantation on long-term survival. Diabetologia. 2002; 45(11):1498508.
    16. Radovancevic B, Konuralp C, Vrtavec B, Radovancevic R, Thomas CD, Zaqqa M, Vaughn WK, frazier OH. Factors predicting 10- year survival after heart transplantation. J Heart Transplant. 2005; 24(2):1569. Go to original source... Go to PubMed...
    17. Meyer SR, Modry DL, Norris CM, Pearson GJ, Bentley MJ, Koshal A, Mullen JC, Rebeyka IM, Ross DB, Wang S. Pretransplant diabetes, not donor age, predicts long-term outcomes in cardiac transplantation. J Card Surg. 2006; 21(2):11724. Go to original source... Go to PubMed...
    18. Russo MJ, Chen JM, Hong KN, Stewart AS, Ascheim DD, Argentino M, Mancini DM, Oz MC, Naka Y. Survival after heart transplantation is not diminished among recipients with uncomplicated diabetes mellitus: an analysis of the United Network of Organ Sparing database. Circulation. 2006; 114(21):22067. Go to original source... Go to PubMed...
    19. Inkeda Y, Tenderech G, Zittermann A, Minami K, Koerfer R. Heart transplantation in insulin-treated diabetic mellitus patients with diabetes-related complications. Transpl Int. 2007; 20(6):52833. Go to original source... Go to PubMed...
    20. Morgan JA, John R, Weinberg AD, Colleti NJ, Mancini DM, Edwards NM. Heart transplantation in diabetic recipients: a decade review of 161 patients at Columbia Presbyterian. J Thorac Cardiovasc Surg. 2004; 127(5):148692. Go to original source... Go to PubMed...
    21. Marelli D, Laks H, Patel B, Kermani R, Marmureanu A, Patel J, Kobashigawa J. Heart transplantation in patiens with diabetes mellitus in the current era. J Heart Lung Tranplant. 2003; 22(10):10917. Go to original source... Go to PubMed...
    22. van Duijnhoven EM, Boots JM, Christiaans MH, van Hoff JP. Metabolic aspects of tacrolimus in renal transplantation. Consequences for the choice of an immunosuppressive regiment and for the management of post-transplant diabetes mellitus. Minerva Urol Nephrol. 2003; 55(1):3342.
    23. Martinez-Dolz L, Almenar L, Martinez-Ortiz L, Arnau MA, Chamorro C, Moro J, Osa A, Rueda J, Garcia C, Palencia M. Predictive factors for development of diabetes mellitus post-heart transplant. Transplant Proc. 2005; 37(9):40646. Go to original source... Go to PubMed...
    24. Grimm M, Rinaldi M, Yonan NA, Arpesella G, Arizon Del Prado JM, Pulpon LA, Villemont JP, Frigerio M, Rodriguez Lambert JL, Crespo-Leiro MG, Almenar L, Duveau D, Ordonez-Fernandez A, Gandjbekhch J, Maccherini M, Laufer G. Superior prevention of acute rejection by tacrolimus vs. Cyclosporine in heart transplant recipients-a large European trial. Am J Transplant. 2006; 6(6):138797. Go to original source... Go to PubMed...
    25. Moro JA, Martinez-Dolz L, Almenar L, Martinez-Ortiz L, Chamorro C, Garcia C, Arnau MA, Rueda J, Zorio E, Salvador A. Impact of diabetes mellitus on heart transplant recipients. Rev Esp Cardiol. 2006; 59(10):10337. Go to original source...
    26. Vincenti F, Friman S, Scheuermann E, Rostaing L, Jenssen T, Campistol JM, Uchida K, Pescovitz MD, Marchetti P, Tuncer M, Citterio F, Wiecek A, Chadban S, El-Shahawy M, Budde K, Goto N. Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Tranpslant 2007; 7(6):15061514. Go to original source... Go to PubMed...
    27. Chen JM, Sinha P, Rajasinghe HA, Suratwala SJ, McCue JD, McCarty MJ, Caliste X, Hauff HM, John R, Edwards NM. Do donor characteristics really matter? Short-and long-term impact of donor characteristics on recipient survival, 19911999. J Heart Lung Transplant 2002; 21:60810. Go to original source... Go to PubMed...
    28. Taylor DO, Edwards LB, Boucek MM. Registry of the International Socienty for Heart and Lung Transplantation: Twenty third official adult heart transplantation report-2006. J Heart Transplant 2006; 25:86979. Go to original source... Go to PubMed...
    29. Kobashigawa JA, Laks H, Wu G, Patel J, Moriguchi J, Hamilton M, Fonarow G, Fishbein M, Ardehali A. The University of California at Angeles heart transplantation experience. Clin Transpl. 2005; 17385.
    30. Kobashigawa JA, Tobis JM, Starling RC, Tuzcu EM, Smith AL, Valantine HA, Yeung AC, mehra MR, Anzai H, Oeser BT, Abeywickrama KH, Murphy J, Crestin N. Multicenter intravascular ultrasound validation study among heart transplant recipients: outcomes after five years. J Am Coll Cardiol. 2005; 45(9):15327. Go to original source... Go to PubMed...
    31. Davidson J, Wilkinson A, Dantal J, Dotta F, Haller H, Hernández D, Kasiske BL, Kiberd B, Krentz A, Legendre Ch, Marchetti P, Markell M, Van Der Woude FJ, Wheeler DC. New-onset diabetes after transplantation: 2003 international consensus guidelines. Transplantation 2003; 75:SS3-SS24. Go to original source... Go to PubMed...

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