Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wisconsin, USA.
Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
Clin Transplant. 2021 Oct;35(10):e14400. doi: 10.1111/ctr.14400. Epub 2021 Oct 3.
Orthotopic heart transplant (OHT) recipients with a body mass index (BMI) > = 35 have worse survival than those with a BMI < 35. Diabetes is a risk factor for mortality. We evaluated the impact of diabetes on mortality rates after OHT in patients with a BMI > 35.
Patients > 18 years who underwent OHT 2008-2017 with a BMI > = 35 were identified in the United Network for Organ Sharing (UNOS) database. Recipient and donor characteristics were compared. A Kaplan Meier analysis was performed. A multivariable Cox proportional hazards model examined the relationship between diabetes and survival. The equivalence of survival outcomes was examined by an unadjusted Cox proportional hazards model and the two one-sided test procedure, using a pre-specified equivalence region.
Patients with diabetes were older, had a higher creatinine, lower bilirubin, fewer months on the waitlist, and the donor was less likely to be on inotropes. Kaplan-Meier analysis showed no difference in patient survival. Recipient factors associated with an increased risk of death were increasing bilirubin and machine ventilation. Increasing ischemic time resulted in an increased hazard of death. Long-term survival outcomes were equivalent.
In OHT recipients with a BMI > 35, there is no statistical difference in longterm survival in recipients with or without diabetes. These results encourage continued consideration for OHT in patients BMI > 35 with coexisting diabetes.
体质量指数（BMI）≥35 的心脏原位移植（OHT）受者的生存率较 BMI＜35 的受者差。糖尿病是死亡的危险因素。我们评估了 BMI＞35 的 OHT 受者中糖尿病对死亡率的影响。
在美国器官共享网络（UNOS）数据库中确定了 2008 年至 2017 年 BMI≥35 且接受 OHT 的年龄＞18 岁的患者。比较了受者和供者的特征。进行 Kaplan-Meier 分析。多变量 Cox 比例风险模型检查了糖尿病与生存之间的关系。通过未调整的 Cox 比例风险模型和双单边检验程序（使用预设的等效区域）检查了生存结果的等效性。
患有糖尿病的患者年龄较大，肌酐较高，胆红素较低，等待时间较短，供者不太可能使用正性肌力药。Kaplan-Meier 分析显示患者生存率无差异。与死亡风险增加相关的受者因素包括胆红素增加和机械通气。缺血时间增加导致死亡的风险增加。长期生存结果等效。
在 BMI＞35 的 OHT 受者中，有或没有糖尿病的受者的长期生存率无统计学差异。这些结果鼓励在 BMI＞35 且合并糖尿病的患者中继续考虑 OHT。
