Saraiva Joana, Sola Emília, Prieto David, Antunes Manuel J
Department of Cardiothoracic Surgery and Thoracic Organ Transplantation, University Hospitals and Faculty of Medicine, Coimbra, Portugal.
Interact Cardiovasc Thorac Surg. 2011 Nov;13(5):499-504; discussion 504. doi: 10.1510/icvts.2010.256321. Epub 2011 Aug 11.
We aimed to compare post-transplantation morbidity and survival among heart transplant recipients with and without diabetes mellitus. A retrospective review of 141 adult patients submitted to heart transplantation from November 2003 to June 2009 (with a minimum follow-up of one year) was undertaken. The patients were divided into two groups: those with (29%) and those without (71%) pre-transplantation diabetes. Those with diabetes were older (57.6 ± 6.1 vs. 52.3 ± 11.1 years; P=0.020) and had lower creatinine clearance (53.6 ± 15.1 vs. 63.7 ± 22.1; P=0.029). Nine patients died in hospital (6.4%; P=non-significant). No significant differences in lipid profiles (diabetes vs. no diabetes) existed before transplantation or at one year afterwards. Patients with diabetes showed a significant deterioration in their one-year lipid profile (158 ± 43 vs.192 ± 38 mg/dl; P=0.001), although one-year fasting diabetic was lower than before (178 ± 80 vs. 138 ± 45 mg/dl; P=0.016). During the first year, 17 (17%) patients previously free of diabetes developed new-onset diabetes. No significant differences were seen in rejection at one year (14% vs. 20%), infection (31% vs. 33%), new-onset renal dysfunction (8% vs. 14%) or mortality (17% vs. 7%). One-year survival was not significantly different (83% vs. 94%), but there was a significant decrease in the survival of individuals with diabetes at three years (73% vs. 91%; P=0.020). No significant difference was found in one-year survival or in terms of higher morbidity in the heart transplant patients with diabetes, but a longer follow-up showed a significant decrease in survival. Nonetheless, the patients with diabetes benefited significantly from transplantation and should not be excluded from it.
我们旨在比较有糖尿病和无糖尿病的心脏移植受者移植后的发病率和生存率。对2003年11月至2009年6月接受心脏移植的141例成年患者（至少随访一年）进行了回顾性研究。患者分为两组：移植前有糖尿病的患者（29%）和无糖尿病的患者（71%）。有糖尿病的患者年龄较大（57.6±6.1岁 vs. 52.3±11.1岁；P=0.020），肌酐清除率较低（53.6±15.1 vs. 63.7±22.1；P=0.029）。9例患者在医院死亡（6.4%；P无统计学意义）。移植前或移植后一年，血脂水平（糖尿病组与非糖尿病组）无显著差异。糖尿病患者的一年血脂水平显著恶化（158±43 vs.192±38 mg/dl；P=0.001），尽管一年空腹血糖低于移植前（178±80 vs. 138±45 mg/dl；P=0.016）。在第一年，17例（17%）既往无糖尿病的患者出现新发糖尿病。一年时在排斥反应（14% vs. 20%）、感染（31% vs. 33%）、新发肾功能不全（8% vs. 14%）或死亡率（17% vs. 7%）方面未见显著差异。一年生存率无显著差异（83% vs. 94%），但糖尿病患者三年生存率显著降低（73% vs. 91%；P=0.020）。糖尿病心脏移植患者的一年生存率或较高发病率方面未发现显著差异，但更长时间的随访显示生存率显著降低。尽管如此，糖尿病患者从移植中显著获益，不应被排除在外。
