Ikeda Yoshifumi, Tenderich Gero, Zittermann Armin, Minami Kazutomo, Koerfer Reiner
Department of Cardio-Thoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Bad Oeynhausen, Germany.
Transpl Int. 2007 Jun;20(6):528-33. doi: 10.1111/j.1432-2277.2007.00478.x. Epub 2007 Apr 2.
Heart transplantation is the most effective therapy for end-stage heart failure in patients with diabetes mellitus (DM). However, diabetes-related complications (DRCs) are a relative contraindication for heart transplantation. Nevertheless, the increasing prevalence of both DM and congestive heart failure makes it necessary to perform heart transplantation even in those patients with advanced DM. We performed a retrospective analysis on long-term survival in 47 patients with insulin-treated DM and DRCs (group 1). Survival rate and causes of death were compared with data of a group of heart transplant recipients without DM (n = 1061, group 2). Mean follow-up time of all heart transplant recipients was 68.2 months (range: 0-204 months). Overall mortality during follow-up was 42.9%. Long-term survival did not differ significantly between study groups, but tended to be shorter in group 1 than in group 2 (P = 0.07). In group 1, steroid-free immunosuppressive therapy was associated with a higher percentage of long-term survivors compared with no steroid-free immunosuppression. Our data demonstrate that long-term survival is acceptable in heart transplant recipients with preoperatively diagnosed DM and DRCs. Consequently, advanced DM should no longer be a relative contraindication for heart transplantation.
心脏移植是糖尿病（DM）患者终末期心力衰竭最有效的治疗方法。然而，糖尿病相关并发症（DRCs）是心脏移植的相对禁忌证。尽管如此，DM和充血性心力衰竭患病率的不断上升使得即使在晚期DM患者中进行心脏移植也很有必要。我们对47例接受胰岛素治疗且患有DRCs的DM患者（第1组）的长期生存情况进行了回顾性分析。将生存率和死亡原因与一组无DM的心脏移植受者（n = 1061，第2组）的数据进行了比较。所有心脏移植受者的平均随访时间为68.2个月（范围：0 - 204个月）。随访期间的总死亡率为42.9%。研究组之间的长期生存率无显著差异，但第1组的长期生存率往往比第2组短（P = 0.07）。在第1组中，与未采用无类固醇免疫抑制治疗相比，采用无类固醇免疫抑制治疗的长期存活者比例更高。我们的数据表明，术前诊断为DM和DRCs的心脏移植受者的长期生存情况是可以接受的。因此，晚期DM不应再成为心脏移植的相对禁忌证。
