Impact of diabetes mellitus on survival rates after heart transplantation.

AIMS

Heart transplantation (HTx) is the most effective therapy in patients with end-stage heart failure. Diabetes-related 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.