Temporal Changes on the Risks and Complications of Posttransplantion Diabetes Mellitus Following Cardiac Transplantation

Abstract

Background Recent changes in the demographic of cardiac donors and recipients have modulated the rate and risk, associated with posttransplant diabetes mellitus (PTDM). We investigated the secular trends of the risk of PTDM at 1 year and 3 years after transplantation over 30 years and explored its effect on major outcomes. Methods Three hundred and three nondiabetic patients were followed for a minimum of 36 months, after a first cardiac transplantation performed between 1983 and 2011. Based on the year of their transplantation, the patients were divided into 3 eras: (1983-1992 [era 1], 1993-2002 [era 2], and 2003-2011 [era 3]). Results In eras 1, 2, and 3, the proportions of patients with PTDM at 1 versus 3 years were 23% versus 39%, 21% versus 26%, and 33% versus 38%, respectively. Independent risk factors predicting PTDM at one year were recipient's age, duration of cold ischemic time, treatment with furosemide, and tacrolimus. There was a trend for overall survival being worse for patients with PTDM in comparison to patients without PTDM (p = 0.08). Patients with PTDM exhibited a significantly higher rate of renal failure over a median follow-up of 10 years (p = 0.03). Conclusion The development of PTDM following cardiac transplantation approaches 40% at 3 years and has not significantly changed over thirty years. The presence of PTDM is weakly associated with an increased mortality and is significantly associated with a worsening in renal function long-term following cardiac transplantation.

Impact of diabetes mellitus on clinical outcomes after heart transplantation

“…Prior studies in solid organ transplant recipients identified several risk factors for developing PTDM including older age, higher BMI, recipient viral infections such as CMV and hepatitis C, and use of immunosuppressants such as high‐dose steroids and tacrolimus 23 . Recent data from HTx recipient cohorts demonstrated similar risk factors for PTDM 7–10 . Our study found that pretransplant recipient CMV IgG seropositivity was a risk factor for PTDM diagnosis at 1‐year follow‐up.…”

“…23 Recent data from HTx recipient cohorts demonstrated similar risk factors for PTDM. [7][8][9][10] Our study found that pretransplant recipient CMV IgG seropositivity was a risk factor for PTDM diagnosis at 1year follow-up. The mechanism underlying this observed association remains unknown.…”

“…In a study of 303 patients without pretransplant DM, PTDM as a time-dependent variable was not found to be a significant risk factor for mortality, but was significantly associated with renal failure. 9 In contrast, another study of 345 patients demonstrated that patients with PTDM, compared to those who did not, had worse survival but did not have significantly worse CAV, rejection, or renal failure outcomes. 8 A recent retrospective analysis of the ISHLT Registry of 26,263 patients demonstrated that development of PTDM was associated with a higher risk for development of severe renal dysfunction and mortality.…”

“…6 However, despite its prevalence, there is limited data on the risk factors for PTDM and its impact on outcomes in HTx recipients. [7][8][9][10] As DM is a risk factor for cardiac allograft vasculopathy (CAV), one of the leading causes of long-term graft failure, there is an urgent need to identify and manage DM in HTx recipients. 11 More is known in the context of kidney and liver transplant where it is established that development of PTDM is associated with increased major cardiac events, graft failure, and mortality.…”

“…PTDM is common, with a prevalence of 21.6% at 1 year and 34.5% at 5 years post‐HTx in the United States 6 . However, despite its prevalence, there is limited data on the risk factors for PTDM and its impact on outcomes in HTx recipients 7–10 . As DM is a risk factor for cardiac allograft vasculopathy (CAV), one of the leading causes of long‐term graft failure, there is an urgent need to identify and manage DM in HTx recipients 11 …”