J Korean Med Sci.  2012 Dec;27(12):1460-1467. 10.3346/jkms.2012.27.12.1460.

The Clinical Course and Outcomes of Post-Transplantation Diabetes Mellitus after Heart Transplantation

• Cho MS
• Choi HI
• Kim IO
• Jung SH
• Yun TJ
• Lee JW
• Kim MS
• Kim JJ

• KMID: 2157967
• DOI: http://doi.org/10.3346/jkms.2012.27.12.1460

Abstract

The aim of this study was to describe in more detail the predisposition, natural course, and clinical impact of post-transplantation diabetes mellitus (PTDM) after heart transplantation (HT). The characteristics and clinical outcomes of 54 patients with PTDM were compared with those of 140 patients without PTDM. The mean age of PTDM patients was significantly higher than controls (48.9 +/- 9.3 vs 38.6 +/- 13.3 yr, respectively, P = 0.001), and ischemic heart disease was a more common indication of HT (20.4% [11/54] vs 7.1% [10/140], respectively, P = 0.008). In multivariate analysis, only recipient age (odds ratio, 1.80; 95% confidence interval, 1.35-2.40; P = 0.001) was associated with PTDM development. In 18 patients (33%), PTDM was reversed during the follow-up period, and the reversal of PTDM was critically dependent on the time taken to develop PTDM (1.9 +/- 1.0 months in the reversed group vs 14.5 +/- 25.3 months in the maintained group, P = 0.005). The 5-yr incidence of late infection (after 6 months) was higher in the PTDM group than in the control group (30.4% +/- 7.1% vs 15.4% +/- 3.3%, respectively, P = 0.031). However, the 5-yr overall survival rate was not different (92.9% +/- 4.1% vs 85.8% +/- 3.2%, respectively, P = 0.220). In conclusion, PTDM after HT is reversible in one-third of patients and is not a critical factor in patient survival after HT.

Keyword

PTDM; Heart Transplantation; Prognosis; Cardiac Allograft Vasculopathy

MeSH Terms

Adult
Cohort Studies
Diabetes Mellitus/epidemiology/*etiology/mortality
Female
Follow-Up Studies
Heart Transplantation/*adverse effects
Hemoglobin A, Glycosylated/analysis
Humans
Incidence
Infection/etiology
Male
Middle Aged
Registries
Survival Rate
Transplantation, Homologous
Treatment Outcome
Hemoglobin A, Glycosylated

Figure

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  Fig. 1 Temporal pattern of PTDM onset and reversal of PTDM.

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  Fig. 2 The clinical impact of PTDM. (A) Five-year overall survival rate; (B) Five-year cardiac allograft vasculopathy incidence; (C) Five-year rejection incidence; (D) Immediate, early, and late infection incidence after HT.

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