Does Diabetes Influence Post-Transplant Survival in CF-axial LVAD BTT Patients?

Abstract

Diabetes is an important factor in post-transplant survival. However its impact on post-transplant survival of Continuous Flow (CF) axial left ventricular assist device (LVAD) i.e. Heartmate II (HM II) bridge to transplant (BTT) population has not been studied. This study addresses the influence of Diabetes type II (DM type II) in this population. The study consisted of two cohorts derived from the UNOS database (2005-2015). Cohort 1 consisted of Type II Diabetes patients with HM II (n=1172) and without HM II (n=1097). Cohort 2 consisted of HM II patients with DM type II (n=1172) and without DM type II (n=1171). Cox's proportional hazards regression was used to investigate the effect of diabetes on post-transplant survival in this population. Hazard ratio (OR) and the 95% confidence interval (CI) were calculated with statistical significance set at p< 0.05. Propensity score matching was done to match HMII recipients with Type II diabetes and without diabetes. Analyses were done using IBM SPSS software by logistic regression on the group indicator which then uses the propensity score obtained to select matched cohorts. Kaplan Meir survival curves were generated for 2-year post-transplant survival RESULTS: The Kaplan Meir survival curve for cohort 1 showed that DM type II patients had better survival when they were bridged to transplant with HM II. The Hazard ratio (OR) for Cohort 1 was 0.717(p=0.00514)). In cohort 2 the Kaplan Meir survival curve showed that HMII without DM type II had better survival than those with type II DM. The hazard ratio (OR) for Cohort 2 was 1.31 (p=0.0209). The cohorts were propensity-matched. This study shows for the first time that HM II implantation in DM type II patients have a better 2 year post-transplant survival as opposed to those without the device. This effect is probably best explained by improved hemodynamics on the endothelium in CF axial LVAD patients.