Marelli Daniel, Laks Hillel, Patel Bijal, Kermani Reza, Marmureanu Alexander, Patel Jignesh, Kobashigawa Jon
Heart Transplant Program, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
J Heart Lung Transplant. 2003 Oct;22(10):1091-7. doi: 10.1016/s1053-2498(02)01219-6.
In this study, we used a single-institution database to examine the risks of heart transplantation in patients with diabetes mellitus (DM).
Recipients 18 years and older who underwent cardiac transplantation from July 1994 to December 2000 were reviewed; 101 consecutive patients with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were compared with 244 patients who did not have DM and who received standard donor hearts. Survival, renal function (serum creatinine concentration), development of transplant coronary artery disease (TCAD), severe rejection, and infection (requiring hospitalization) were analyzed.
Patients with DM were older (mean age, 57.1 years vs 51.4 years), had greater body mass index (mean, 26.7 vs 24.1 kg/m(2), p < 0.02), and more commonly had ischemic cardiomyopathy (58% vs 43%, p = 0.02). We found a trend toward decreased survival for those with DM at 1 year (85.1% vs 90.9%; p = 0.12). Five-year survival was 81.6% for both groups. Mean follow-up time was 4.1 years. Infection rate within 3 months was greater among those with DM (14% vs 3%, odds ration = 5.09; 95% confidence interval, 1.59-16.23). Freedom from infection at 4 years was 71.0% for patients with DM and 85.0% for those without DM (p = 0.02). Freedom from rejection at 4 years was similar (70.6% vs 73.6%, p = 0.69). At 4 years, transplant coronary artery disease (TCAD)-free survival was 69.5% for those with DM and 81.6% for those without (p = 0.23). Mean serum creatinine concentration at 4 years after transplant was 1.5 mg/dl in patients with DM (vs 1.4, p = 0.28). Multivariate analysis showed increased baseline creatinine level as a significant risk factor for survival and showed pre-transplant ischemic cardiomyopathy as a risk factor for TCAD in both groups. Body mass index >30 was a significant risk factor for survival among patients with DM.
We found an increased risk of serious infections in patients with DM, particularly in the early post-operative period. Careful consideration of obesity and renal function during evaluation of candidacy is indicated.
在本研究中，我们使用单机构数据库来研究糖尿病（DM）患者进行心脏移植的风险。
回顾了1994年7月至2000年12月接受心脏移植的18岁及以上受者；将101例连续的胰岛素依赖型糖尿病和非胰岛素依赖型糖尿病患者与244例无DM且接受标准供心的患者进行比较。分析了生存率、肾功能（血清肌酐浓度）、移植冠状动脉疾病（TCAD）的发生、严重排斥反应和感染（需住院治疗）情况。
DM患者年龄更大（平均年龄，57.1岁对51.4岁），体重指数更高（平均，26.7对24.1kg/m²，p<0.02），更常见缺血性心肌病（58%对43%，p=0.02）。我们发现DM患者1年时生存率有下降趋势（85.1%对90.9%；p=0.12）。两组5年生存率均为81.6%。平均随访时间为4.1年。DM患者3个月内感染率更高（14%对3%，优势比=5.09；95%置信区间，1.59 - 16.23）。DM患者4年无感染生存率为71.0%，无DM患者为85.0%（p=0.02）。4年无排斥反应生存率相似（70.6%对73.6%，p=0.69）。4年时，DM患者无移植冠状动脉疾病（TCAD）生存率为69.5%，无DM患者为81.6%（p=0.23）。移植后4年DM患者平均血清肌酐浓度为1.5mg/dl（对1.4，p=0.28）。多因素分析显示基线肌酐水平升高是生存的显著危险因素，且移植前缺血性心肌病是两组TCAD的危险因素。体重指数>30是DM患者生存的显著危险因素。
我们发现DM患者严重感染风险增加，尤其是在术后早期。在评估候选资格时，需仔细考虑肥胖和肾功能情况。
