Livi U, Caforio A L, Grassi G, Boffa G M, Gambino A, Milano A, Bianco R, Casula R, Thiene G, Casarotto D
Department of Cardiovascular Surgery, University of Padova Medical School, Italy.
J Cardiovasc Surg (Torino). 1994 Dec;35(6 Suppl 1):115-8.
Diabetes mellitus (DM) has been considered a relative contraindication to heart transplantation (HTx) because of possible increased infection rates and worsening DM with prednisone immunosuppression. The introduction of cyclosporine has allowed us to reduce the dosage of oral steroids and to accept DM patients (pts) for HTx. We reviewed the mid-term outcome of our DM pts who had undergone HTx.
Out of 257 HTx recipients, 19 males and 3 females, aged 53 +/- 8 years, were diabetic. Prior to HTx, DM was controlled with insulin in 5, with oral hypoglycemic agents in 7 and with diet in the remaining patients. Immunosuppression consisted of cyclosporine and azathioprine; low-dose prednisone was added in 10 patients because of repeated rejections.
All patients survived HTx and were followed 2 to 75 (mean 38 +/- 21) months. There were 4 late deaths, with actuarial survival of 84% at 5 years. DM was more difficult to control after HTx (12 patients requiring insulin vs 5 pre-HTx), but comparison of diabetic vs non diabetic patients following HTx showed no significant difference in frequency of rejection or infection during the 1st year (2.6 +/- 1.6 vs 2.1 +/- 1.5; 0.5 +/- 0.4 vs 0.4 +/- 0.3 episode/patient respectively) and in 5-year actuarial survival (84% vs 77%). Renal function is preserved in all DM patients, hypertension has developed in 11/18 (61%); annual post-HTx cardiac catheterisation has shown normal graft function and coronary arteries in all but 2 patients.
Mid-term results indicate that HTx can be safely performed in diabetic patients; a longer follow-up is required to determine whether DM is no longer a contraindication to HTx.
由于使用泼尼松进行免疫抑制可能会增加感染率以及使糖尿病病情恶化，糖尿病一直被视为心脏移植（HTx）的相对禁忌证。环孢素的应用使我们能够减少口服类固醇的剂量，并接受糖尿病患者进行心脏移植。我们回顾了接受心脏移植的糖尿病患者的中期结局。
在257例心脏移植受者中，19例男性和3例女性，年龄53±8岁，患有糖尿病。心脏移植前，5例患者使用胰岛素控制糖尿病，7例使用口服降糖药，其余患者通过饮食控制。免疫抑制方案包括环孢素和硫唑嘌呤；10例患者因反复发生排斥反应而加用小剂量泼尼松。
所有患者均存活了心脏移植手术，并接受了2至75（平均38±21）个月的随访。有4例晚期死亡，5年实际生存率为84%。心脏移植后糖尿病更难控制（12例患者需要胰岛素治疗，而心脏移植前为5例），但心脏移植后糖尿病患者与非糖尿病患者相比，在第一年的排斥反应或感染频率（分别为2.6±1.6次/患者和2.1±1.5次/患者；0.5±0.4次/患者和0.4±0.3次/患者）以及5年实际生存率（84%对77%）方面无显著差异。所有糖尿病患者的肾功能均得以保留，11/18（61%）患者出现了高血压；除2例患者外，所有患者每年的心脏移植后心导管检查均显示移植心脏功能和冠状动脉正常。
中期结果表明，糖尿病患者可以安全地进行心脏移植；需要更长时间的随访来确定糖尿病是否不再是心脏移植的禁忌证。
