Impact of Pre-Operative Diabetes Mellitus Upon Early and Late Survival After Heart Transplantation: A Possible Era Effect

Klingenberg, R; Gleissner, Christian A.; Koch, Achim; Schnabel, Philipp A.; Sack, Falk–Udo; Zimmermann, Rainer; Katus, Hugo A.; Dengler, Thomas J.

doi:10.1016/j.healun.2004.09.007

Cited by 38 publications

(39 citation statements)

References 18 publications

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“…2 Meanwhile, new-onset DM has not attracted as much clinical attention as pre-existing DM, and there are few studies on its impact on clinical outcomes after heart transplantation. 20 Klingenberg et al reported in the aforementioned study that the overall survival rate was similar between the non-diabetic (n=151) and new-onset DM patients (n=39; P=0.50), 7 and Cho et al also reported that the mid-term survival rate was not significantly different (92.9±4.1% vs. 85.8±3.2%; P=0.22) between the non-diabetic (n=140) and new-onset DM patients (n=54). 8 The present study involved a larger cohort of new-onset DM patients (n=88) during a longer follow-up period (median, 5.4 transplantation compared with new-onset or pre-existing DM patients; (2) there was no significant difference in long-term overall or event-free survival rate between the new-onset DM and the pre-existing DM groups; and (3) advanced age (>50), male gender, and high systolic PAP were significant risk factors for new-onset DM.…”

Section: Risk Of New-onset Dmmentioning

confidence: 91%

“…On univariate time-varying Cox analysis, pre-existing DM was associated with increased risk of all-cause death (P=0.038), CVA (P=0.039) and severe CKD (P=0.025), whereas new-onset DM significantly mortality after heart transplantation showed mixed results: Klingenberg et al reported on a series of 243 patients receiving heart transplantation and noted better long-term survival in the non-diabetic recipients (P=0.004) compared with the recipients with pre-existing DM. 7 In contrast, Russo et al reported that the survival rates after heart transplantation were similar between the uncomplicated diabetic and the non-diabetic patients. 2 Meanwhile, new-onset DM has not attracted as much clinical attention as pre-existing DM, and there are few studies on its impact on clinical outcomes after heart transplantation.…”

Section: Risk Of New-onset Dmmentioning

confidence: 94%

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

Kim

Jung

Kim

et al. 2017

Circ J

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Section: Risk Of New-onset Dmmentioning

confidence: 91%

Section: Risk Of New-onset Dmmentioning

confidence: 94%

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

Kim

Jung

Kim

et al. 2017

Circ J

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“…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.…”

Section: Editorial P 2206 Clinical Perspective P 2287mentioning

confidence: 99%

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

et al. 2006

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Background-This study compares posttransplantation outcomes of survival and morbidity among recipients with and without diabetes mellitus (DM). Methods and Results-The United Network of Organ Sharing (UNOS) provided deidentified patient-level data. Primary analysis focused on 20 412 first-time heart transplant recipients aged Ն18 years who underwent transplantation between January 1, 1995, and December 31, 2005. To determine severity of DM, DM recipients were stratified by their aggregate number of diabetes-related complications (DRCs), including pretransplantation history of renal failure (serum creatinineϭ2.5 mg/dL), peripheral vascular disease, cerebrovascular accident, and severe obesity (body mass index Ն35 kg/m 2 ). Kaplan-Meier analysis was performed to compare time to event. Although posttransplantation survival was significantly better (PϽ0.001) among patients without DM (median survival 10.1 years) than among those with DM (9.0 years), survival did not differ (Pϭ0.08) between those without DM (10.1 years) and those with uncomplicated DM (0 DRCs; 9.3 years). Among those with DM, survival was worse with each additional DRC: 0 DRC, 9.3 years; 1 DRC, 6.7 years; and Ն2 DRCs, 3.6 years. Although acute rejection and transplant coronary artery disease-free survival did not differ between groups, renal failure and severe infection-free survival were worse in those with DM and were inversely related to the number of DRCs. Conclusions-Posttransplantation survival among patients with uncomplicated DM was not significantly different than that among nondiabetics. However, when stratified by disease severity, recipients with more severe diabetes had significantly worse survival than nondiabetics. Therefore, although DM alone should not be a contraindication to heart transplantation, given the critical shortage of transplantable organs, maximal benefit may be achieved by exploring alternative treatment options in patients with severe DM. These include use of high-risk transplant lists and destination therapy. (Circulation. 2006;114:2280-2287.)

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“…Diabetes mellitus and insulin resistance are frequently encountered metabolic complications in recipients of heart transplantation [119]. Heart transplant recipients may have pre-existing diabetes mellitus or may develop new onset diabetes mellitus after the heart transplant (NODAT) [119,121]. Approximately 23% of heart transplant recipients develop post-transplant diabetes within one year of heart transplantation [1].…”

Section: Diabetes Mellitusmentioning

confidence: 99%

“…Several risk factors are identified to be the predisposing elements for the development of NODAT [122][123][124]. They are delineated below: a) Blood glucose of >5.6 mmol/liter prior to the transplant [122] b) Family history of diabetes c) Pre-transplant over weight [124] d) Requirement for insulin on the second day of post-transplant [122,123] e) Administration of immunosuppressive agents (CNIs and Corticosteroids) [125] f) Asymptomatic CMV infection [126] Immunosuppressive agents vary significantly in their potential to cause diabetes or worsen preexisting diabetes [121,127]. Although both CNIs and corticosteroids are significantly diabetogenic, the greatest risk of NODAT development is associated with the use of steroids [128][129][130].…”

Section: Diabetes Mellitusmentioning

confidence: 99%

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

Munagala¹,

Phancao²

2018

obm.transplant

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Heart transplant remains the gold standard therapy for patients with end stage heart disease and offers improved survival and quality of life. Significant progress has been achieved in improving one-year mortality after heart transplantation. Nonetheless, longterm graft survival has not changed significantly over the past few decades. Long term survival of heart transplant recipients is limited by chronic rejection, cardiac allograft vasculopathy (CAV), and malignancy. CAV is a major contributor for graft failure and mortality after the first year of in heart transplant recipients. CAV is a proliferative vasculopathy characterized by diffuse myointimal hyperplasia and progressive narrowing of the graft vessels. Both immune dependent and independent factors have been shown to contribute to the pathogenesis of CAV. Understanding these risk factors is essential in developing preventative and therapeutic strategies. Angiography with Intravascular ultrasound has become the key diagnostic tool in the early detection of CAV as well as prognostication. Echocardiographic assessment of allograft function in conjunction with coronary angiographic findings are used in assessing the severity of CAV. Adjustment of immunosuppression and statins remain the initial steps in the management of CAV. Retransplantation is the definitive treatment for severe CAV, however, the paucity of organs along with increased mortality associated with retransplantation makes it a less desirable option. Remarkable progress has been achieved in the understanding of pathogenesis, risk factors for CAV and plaque morphology. Nevertheless, significant knowledge gaps persist in scientific understanding of risk factors, pathogenesis, prevention and treatment of CAV. Further research is warranted to fill these gaps, develop diagnostic modalities to facilitate early detection of CAV, and management strategies to Improve graft tolerance and immune modulation. This review focuses on summarizing the pathogenesis and risk factors for CAV.

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Impact of Pre-Operative Diabetes Mellitus Upon Early and Late Survival After Heart Transplantation: A Possible Era Effect

Cited by 38 publications

References 18 publications

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

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

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

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

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Impact of Pre-Operative Diabetes Mellitus Upon Early and Late Survival After Heart Transplantation: A Possible Era Effect

Cited by 38 publications

References 18 publications

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

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

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

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

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

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