Clinical Study Of Neonatal Diabetes Mellitus After Orthotopic Transplantation And Transplantation In Patients With Heart Transplantation

Background and Objective With the increasing incidence of diabetes in the worldwide, more and more patients with diabetes need to be incorporated into the heart transplant waiting list. However, diabetes was still as a relative contraindication to heart transplant.In this retrospectively study,we compared perioperative and medium survival rates of heart transplant between non-diabetic patients and diabetic patients, in order to clarify the effect of preoperative diabetes to patients undergoing heart transplantation.Materials and Methods From June2004to May2012, the heart transplant center of Fuwai Hospital had completed a total of301cases, and all patients clinical data and follow-up information were conducted a detail database. In accordance with the2012American Diabetes Association (ADA) diagnostic criteria,301patients were divided into diabetic group and non-diabetic group.The two groups clinical characteristic data and perioperative recovery data were compared.The perioperative recovery data included perioperative cardiopulmonary bypass time, duration of mechanical ventilation, perioperative complications required (CRRT, ECMO and IABP) support, ICU length of stay and total hospital stay. The perioperative survival and medium-term survival between two groups were compared.Results Among301heart transplant patients,with median age45years (12-68years), diabetic patients accounted for15.0%. Between diabetic group and non-diabetic group,the total time of cardiopulmonary bypass grafting, perioperative mechanical ventilation time,perioperative complications required (CRRT,ECMO and IABP)support rate,ICU length of stay and total hospital stay were not statistically different(P>0.05). The median follow-up was37months (6-95months). After transplantation period, the survival rates of diabetic group and non-diabetic group were as follows:1month,97.7%vs.97.2%;6months,95.3%vs.96.0%;1year,93.2%vs.96.0%;2years,89.5%vs.93.3%;3years,89.5%vs.92.6%;4years,83.5%vs.91.9%;5years,75.1%vs.89.3%;6years,75.1%vs.89.3%;7years,75.1%vs.87.4%.Comparing two groups of patients at each time, survival rates were not statistically different (P>0.05).Conclusions Among301heart transplant patients,preoperative diabetic patients accounted for15.0%. The perioperative and medium-term survival was not affected in heart transplant diabetes patients with non-end-organ damage and restrictive glycemic control. Objective The objective of this study was to determine the incidence, risk factors and effect of medium-term survival for new onset posttransplantation diabetes mellitus (PTDM) among heart transplant patients.Methods From June2004to May2012, the center transplant of Fuwai Hospital completed a total of301heart transplant cases, Allograft survival time^6months and without diabetes before transplantation of226patients were selected as research subjects. According to the American Diabetes Association2006revision of the diagnosis of diabetes standard, the subjects were divided into PTDM and NPTDM.Analyze all variables that could be related to the development of PTDM during follow-up, and then1.Describe the incidence of PTDM among the226patients2.Student t-test, Wilcoxon rank sum test and X2test were used for univariate statistical analysis and logistic regression for multivariate analysis.3.Compare medium-term survival between PTDM and NPTDM group by Kaplan-Meier method and Log rank test analysis.Results1.During a follow-up of median41months(6-95months), the incidence of PTDM was23.5%in226patients,with mean age43years (12-68years),treated with cyclosporine77.4%and tacrolimus22.1%.2.The univariate analysis showed that patients developing PTDM had older age, a history of hypertension, as well as the first-degree relatives of a family history of diabetes. Multivariate analysis identified the following as predictive factors for the development of PTDM:age([OR]:1.05,95%CI:1.01-1.09, P=0.01),the first-degree relatives of a family history of diabetes ([OR]:1.90,95%CI:1.04-4.10,P=0.03).3.At end of1,2,3,4,5,6and7year, the survival rates of heart transplantat patients by Kaplan-Meier method estimation were100%,98.0%,98.0%,95.1%,89.8%,82.9%,75.4%in PTDM group;98.2%,95.1%,94.2%,94.2%,92.4%,92.4%,92.4%in NPTDM group. Log Rank test displayed there was no significant difference between two survival curves(P=0.46).Conclusions During a follow-up of median41months, the incidence of PTDM was23.5%. older age and first-degree relatives of a family history of diabetes were predictive factors for the development of PTDM. Under restrictive glycemic control, the medium-term survival was not affected in patients with PTDM.