成人心脏移植后新发糖尿病与肾功能障碍或死亡风险。
New-onset Diabetes Mellitus After Adult Heart Transplantation and the Risk of Renal Dysfunction or Mortality.
机构信息
Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, MA.
United Network for Organ Sharing (UNOS), Richmond, VA.
出版信息
Transplantation. 2022 Jan 1;106(1):178-187. doi: 10.1097/TP.0000000000003647.
BACKGROUND
Diabetes mellitus (DM) may occur either pre-heart transplantation (HT) or as new-onset DM post-HT. We sought to define the contemporary incidence of post-HT DM, evaluate risk factors for post-HT DM, and assess the impact of post-HT DM on major outcomes.
METHODS
The cohort included International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry adult primary HT-alone recipients, transplanted January 1995-June 2017, who survived to 1 y post-HT. DM status was characterized as (1) no DM pre-HT or post-HT; (2) pre-HT DM; or (3) post-HT DM (onset within 5 y of HT). Cox proportional hazards models were constructed to identify risk factors for post-HT DM onset, as well as risk factors for post-HT severe renal dysfunction and death/retransplantation.
RESULTS
Of 26 263 eligible subjects, 57% had no DM pre-HT or post-HT, 22% had pre-HT DM, and 21% had new-onset post-HT DM. Risk factors for the development of post-HT DM included use of tacrolimus or steroids at 1 y post-HT, as well as higher recipient age, female sex, ischemic cardiomyopathy, higher body mass index, pre-HT dialysis, and pre-HT steroid use. Post-HT DM within 5 y was associated with increased subsequent severe renal dysfunction (hazard ratio, 1.89; 95% confidence interval, 1.77-2.01) and death/retransplantation (hazard ratio, 1.38; 95% confidence interval, 1.32-1.45), compared with patients without post-HT DM.
CONCLUSIONS
Post-HT DM is common, occurring in 21% of recipients within 5 y of HT. Post-HT DM is associated with increased risk of severe renal dysfunction and death or retransplantation.
背景
糖尿病（DM）可能在心脏移植（HT）前发生（即预 HT 期 DM），也可能在 HT 后新发 DM。我们旨在明确 HT 后 DM 的当代发病率，评估 HT 后 DM 的风险因素，并评估其对主要结局的影响。
方法
该队列纳入了国际心肺移植学会胸器官移植登记处 1995 年 1 月至 2017 年 6 月期间接受 HT 的成人原发性 HT 单器官移植且存活至 HT 后 1 年的患者。DM 状态特征为：（1）HT 前或 HT 后均无 DM；（2）HT 前 DM；或（3）HT 后 DM（HT 后 5 年内发病）。构建 Cox 比例风险模型以确定 HT 后 DM 发病的风险因素，以及 HT 后严重肾功能障碍和死亡/再次移植的风险因素。
结果
在 26263 例合格患者中，57%无 HT 前或 HT 后 DM，22%有 HT 前 DM，21%有新发 HT 后 DM。HT 后 DM 发病的风险因素包括 HT 后 1 年时使用他克莫司或类固醇，以及较高的受者年龄、女性、缺血性心肌病、较高的体重指数、HT 前透析和 HT 前类固醇使用。与无 HT 后 DM 的患者相比，HT 后 5 年内发生 DM 与随后发生严重肾功能障碍（风险比，1.89；95%置信区间，1.77-2.01）和死亡/再次移植（风险比，1.38；95%置信区间，1.32-1.45）的风险增加相关。
结论
HT 后 DM 较为常见，在 HT 后 5 年内，21%的患者会发生 DM。HT 后 DM 与严重肾功能障碍和死亡或再次移植的风险增加相关。
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