Kim Ho Jin, Jung Sung-Ho, Kim Jae-Joong, Yun Tae-Jin, Kim Joon Bum, Choo Suk Jung, Chung Cheol Hyun, Lee Jae Won
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine.
Circ J. 2017 May 25;81(6):806-814. doi: 10.1253/circj.CJ-16-0963. Epub 2017 Mar 24.
New-onset diabetes mellitus (DM) can occur as a serious complication after heart transplantation, but the comparative data on its clinical impact on survival and on transplant-related adverse events are limited.
We reviewed a total of consecutive 391 patients aged ≥17 years undergoing isolated orthotopic heart transplantation at the present institution from 1992 to 2013. The entire cohort was divided into 3 groups: (1) no diabetes (n=257); (2) pre-existing DM (n=46); and (3) new-onset DM (n=88). Early and long-term clinical outcomes were compared across the 3 groups. Early death occurred in 8 patients (2.0%). Of the 345 non-diabetic patients before transplantation, 88 (25.5%) developed new-onset DM postoperatively. During follow-up, 83 (21.2%) died. On time-varying Cox analysis, new-onset DM was associated with increased risk for overall death (HR, 2.11; 95% CI: 1.26-3.55) and tended to have a greater risk for severe chronic kidney disease (HR, 1.77; 95% CI: 0.94-3.44). Compared with the no-diabetes group, the new-onset DM group had a worse survival rate (P=0.035), but a similar survival rate to that of the pre-existing DM group (P=0.364).
New-onset DM has a negative effect on long-term survival and kidney function after heart transplantation. Further studies are warranted to evaluate the relevance of early diagnosis and timely control of new-onset DM to improve long-term survival.
新发糖尿病（DM）可作为心脏移植术后的一种严重并发症出现，但关于其对生存及移植相关不良事件临床影响的比较数据有限。
我们回顾了1992年至2013年在本机构接受单纯原位心脏移植的连续391例年龄≥17岁的患者。整个队列分为3组：（1）无糖尿病（n = 257）；（2）既往有DM（n = 46）；（3）新发DM（n = 88）。对3组患者的早期和长期临床结局进行了比较。8例患者（2.0%）发生早期死亡。在移植前的345例非糖尿病患者中，88例（25.5%）术后发生新发DM。随访期间，83例（21.2%）死亡。在时变Cox分析中，新发DM与全因死亡风险增加相关（HR，2.11；95%CI：1.26 - 3.55），且发生严重慢性肾脏病的风险有增加趋势（HR，1.77；95%CI：0.94 - 3.44）。与无糖尿病组相比，新发DM组的生存率更差（P = 0.035），但与既往有DM组的生存率相似（P = 0.364）。
新发DM对心脏移植后的长期生存及肾功能有负面影响。有必要进一步研究评估早期诊断和及时控制新发DM对改善长期生存的相关性。
