Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, MA.
United Network for Organ Sharing (UNOS), Richmond, VA.
Transplantation. 2022 Jan 1;106(1):178-187. doi: 10.1097/TP.0000000000003647.
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.
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.
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.
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.
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。
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。
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。
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。
