Abstract
BackgroundEndocrine disorders in patients after heart transplantation (HT) remain understudied. We aimed to assess endocrine profiles and management of HT recipients in the early post- transplant period.MethodsWe conducted a retrospective cohort study on 123 consecutive HT recipients in the Advanced Heart Failure and Transplantation Programme between 2009 and 2018. All recipients had per-protocol endocrine follow-up within the first postoperative year. The median time to first post-transplant endocrine follow-up was 3 months (IQR 2–4). We assessed the incidence of vitamin D deficiency, bone mineral density, history of low energy fractures, hypogonadism in male recipients, posttransplant diabetes mellitus, and thyroid and parathyroid function.ResultsWe enrolled 22 women and 101 men of median age 57 years (IQR 50–63). Post-transplant diabetes mellitus developed in 14 patients (11.4%). 18 of 25 patients (14.6%) with preexisting type 2 diabetes mellitus required intensification of antidiabetic therapy. 38 male patients (40.4%) had hypogonadism. 5 patients (4.6%) were hypothyroid and 10 (9.3%) latent hyperthyroid. Secondary hyperparathyroidism was present in 19 (17.3%), 25-hydroxyvitamin D deficiency in 64 (54.7%) of patients. Osteoporosis was present in 26 (21.1%), osteopenia in 59 (48.0%) patients. 47 vertebral fractures, 3 hip and 1 humerus fractures occurred in 21 patients. Most of the patients had coincidence of two or three disorders, while less than 5% did not have any endocrine irregularities. All patients received calcium and vitamin D supplements. Forty-six patients (37.4%) were treated with zoledronic acid, 12 (9.8%) with oral bisphosphonates. Two patients were treated with teriparatide.ConclusionsThe prevalence of multiple endocrine disorders early after heart transplantation is high. Assessment and management of increased fracture risk and all other potentially affected endocrine axes should be considered as a standard of care in this early period.
Highlights
Endocrine disorders in patients after heart transplantation (HT) remain understudied
Diabetes mellitus Prevalence of diabetes mellitus is presented in Table 2. 39 (31.7%) of the included patients had DM or post-transplant diabetes mellitus (PTDM)
In patients who were diagnosed with DM prior to HT, the antidiabetic therapy was intensified in the early period after HT for 18 (14.6%), and 3 (2.4%) patients had the same treatment in the period between HT and first follow-up at the diabetes clinics
Summary
Endocrine disorders in patients after heart transplantation (HT) remain understudied. We aimed to assess endocrine profiles and management of HT recipients in the early post- transplant period. Improvement of survival after heart transplantation (HT) brings new challenges in recognizing and managing endocrine complications in the patient population [1]. The most dynamic period with the greatest changes in endocrine profile is the first post-transplant year [2–. 4] resulting in vitamin D deficiency, hypogonadism, post-transplant diabetes mellitus (PTDM), and bone loss [2,3,4,5,6,7,8,9]. Many factors have been associated with endocrine changes early after HT: association of glucocorticoid treatment with bone loss and vertebral fractures (VFs) is well established [10]. The calcineurin inhibitors (CNIs) cyclosporine A and tacrolimus are further
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