Bedanova Helena, Ondrasek Jiri, Cerny Jan, Orban Marek, Spinarova Lenka, Hude Petr, Krejci Jan, Nemec Petr
Center of Cardiovascular and Transplant Surgery, Pekarska 53, Brno, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009 Dec;153(4):283-7. doi: 10.5507/bp.2009.047.
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.
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.
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).
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.
心脏移植（HTx）是终末期心力衰竭患者最有效的治疗方法。糖尿病相关并发症是心脏移植的相对禁忌证。本研究的目的是分析心脏移植时糖尿病（DM）及移植后新发糖尿病对长期生存的影响。
对1997年4月至2007年9月在本机构接受心脏移植的所有患者进行回顾性数据库分析。患者分为三组：A组——无糖尿病患者；B组——心脏移植后新发糖尿病患者；C组——心脏移植前患有糖尿病的患者。
手术前患有糖尿病的患者更肥胖，其体重指数（BMI）为27.7±2.90，而A组和B组的BMI分别为24.7±3.37和25.3±3.64（p = 0.0003）。B组患者发生急性排斥反应（根据国际心肺移植学会——ISHLT——分类为1B级及以上）的风险在统计学上显著更高（p = 0.0350）。各组间感染发生率无统计学显著差异（p = 0.5839）。A组的5年生存率为82%，10年生存率为73%。B组相应数字为86%和78%，C组为86%和83%。组间差异无统计学意义（p = 0.2560）。
在我们的研究中，心脏移植后患者的糖尿病对患者的长期生存没有影响。移植后糖尿病增加急性排斥反应的风险。移植前糖尿病与超重或肥胖有关。
