Heart transplantation in patients with diabetes mellitus in the current era

Survival After Heart Transplantation Is Not Diminished Among Recipients With Uncomplicated Diabetes Mellitus

“…Previous studies [7][8][9]14 have attempted to describe posttransplantation morbidity and mortality among diabetic patients. Although offering some insight, these studies, because of limitations in size and follow-up, were unable to draw definitive conclusions regarding the effect of diabetes on heart transplant recipients.…”

“…Given these concerns, diabetes is a relative contraindication to heart transplantation at some centers, 11 and diabetes complicated by end-organ damage is frequently suggested as an indication for long-term support with a ventricular assist device as an alternative to transplantation, in a treatment strategy known as destination therapy. 12,13 Previous studies, [7][8][9]13,14 including studies from our institution, examining posttransplantation survival among diabetic recipients found no significant difference in survival among diabetics compared with nondiabetics. However, by demonstrating a trend toward worse survival among diabetic recipients, these single-center studies, which were limited in size and duration of follow-up, did not end the debate about the effect of diabetes on posttransplantation survival.…”

“…Moreover, there is concern for a multiple-hit phenomenon in which the use of nephrotoxic immunosuppressant drugs further increases the likelihood of renal disease in patients already at risk. Finally, although still unproven, a higher incidence of posttransplantation infection, 7 rejection, 8 and transplant coronary artery disease (TCAD) 9,10 is hypothesized. Given these concerns, diabetes is a relative contraindication to heart transplantation at some centers, 11 and diabetes complicated by end-organ damage is frequently suggested as an indication for long-term support with a ventricular assist device as an alternative to transplantation, in a treatment strategy known as destination therapy.…”

New-Onset Diabetes Mellitus After Heart Transplantation ― Incidence, Risk Factors and Impact on Clinical Outcome ―

“…1 Accordingly, the clinical application of heart transplantation has extended to high-risk recipients with comorbidities such as diabetes mellitus (DM). 2, 3 Concurrently, a growing number of cases of heart failure have been attributed to DM for the last several decades, and the proportion of diabetic candidates enrolled for heart transplantation is increasing. 1, 4 Aside from pre-existing DM, DM may also occur as a complication after heart transplantation, and this newonset DM may further predispose the recipients to greater risk for overall mortality or other transplant-related adverse events.…”

New-onset diabetes after transplantation

“…[1][2][3][4][5] In contrast, data for heart transplant patients are scant. Recent evidence has suggested that patients with diabetes at the time of transplantation have both an increased susceptibility to serious infection 6 and reduced long-term survival. 7 Nevertheless, the incidence and consequences of new-onset diabetes after heart transplantation are not fully elucidated.…”