Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Transpl Int. 2022 Apr 19;35:10113. doi: 10.3389/ti.2022.10113. eCollection 2022.
Post-transplant diabetes mellitus (PTDM) is a frequent complication post-heart transplantation (HT), however long-term prevalence studies are missing. The aim of this study was to determine the prevalence and determinants of PTDM as well as prediabetes long-term post-HT using oral glucose tolerance tests (OGTT). Also, the additional value of OGTT compared to fasting glucose and glycated hemoglobin (HbA1c) was investigated. All patients > 1 year post-HT seen at the outpatient clinic between August 2018 and April 2021 were screened with an OGTT. Patients with known diabetes, an active infection/rejection/malignancy or patients unwilling or unable to undergo OGTT were excluded. In total, 263 patients were screened, 108 were excluded. The included 155 patients had a median age of 54.3 [42.2-64.3] years, and 63 (41%) were female. Median time since HT was 8.5 [4.8-14.5] years. Overall, 51 (33%) had a normal range, 85 (55%) had a prediabetes range and 19 (12%) had a PTDM range test. OGTT identified prediabetes and PTDM in more patients (18% and 50%, respectively), than fasting glucose levels and HbA1c. Age at HT (OR 1.03 (1.00-1.06), = 0.044) was a significant determinant of an abnormal OGTT. Prediabetes as well as PTDM are frequently seen long-term post-HT. OGTT is the preferred screening method.
移植后糖尿病（PTDM）是心脏移植（HT）后的常见并发症，但长期患病率研究尚缺乏。本研究旨在通过口服葡萄糖耐量试验（OGTT）确定 HT 后 PTDM 及糖尿病前期的患病率及其决定因素，并探讨 OGTT 与空腹血糖和糖化血红蛋白（HbA1c）相比的额外价值。
2018 年 8 月至 2021 年 4 月，在门诊就诊的所有 HT 后 > 1 年的患者均接受 OGTT 筛查。排除已知糖尿病、活动性感染/排斥/恶性肿瘤或不愿或不能进行 OGTT 的患者。共有 263 例患者接受了筛查，其中 108 例被排除。纳入的 155 例患者的中位年龄为 54.3[42.2-64.3]岁，63 例（41%）为女性。HT 后中位时间为 8.5[4.8-14.5]年。
总体而言，51 例（33%）患者的 OGTT 结果处于正常范围，85 例（55%）患者处于糖尿病前期范围，19 例（12%）患者处于 PTDM 范围。与空腹血糖和 HbA1c 相比，OGTT 可发现更多的糖尿病前期和 PTDM 患者（分别为 18%和 50%）。
HT 时的年龄（OR 1.03（1.00-1.06）， = 0.044）是 OGTT 异常的一个显著决定因素。
糖尿病前期和 PTDM 在 HT 后长期内均较常见。OGTT 是首选的筛查方法。
