Abstract
Posttransplant diabetes mellitus (PTDM) is a well-recognized complication of heart transplantation and is associated with increased morbidity and mortality. Previous studies have yielded wide ranging estimates in the incidence of PTDM due in part to variable definitions applied. In addition, there is a limited published data on the management of PTDM after heart transplantation and a paucity of studies examining the effects of newer classes of hypoglycaemic drug therapies. In this review, we discuss the role of established glucose-lowering therapies and the rationale and emerging clinical evidence that supports the role of incretin-based therapies (glucagon like peptide- (GLP-) 1 agonists and dipeptidyl peptidase- (DPP-) 4 inhibitors) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of PTDM after heart transplantation. Recently published Consensus Guidelines for the diagnosis of PTDM will hopefully lead to more consistent approaches to the diagnosis of PTDM and provide a platform for the larger-scale multicentre trials that will be needed to determine the role of these newer therapies in the management of PTDM.
Highlights
Diabetes mellitus is a common complication after heart transplantation
Posttransplant diabetes mellitus (PTDM) has been associated with increased rates of serious infection [2, 3], graft-related complications such as graft rejection and graft loss [4], and reduced long-term survival compared to nondiabetic recipients [1]
Have been conducted in renal transplant recipients; management strategies for PTDM after renal transplantation may not be appropriate for heart transplant recipients
Summary
In the most recent report of the International Society of Heart and Lung Transplantation (ISHLT) Registry, the prevalence of diabetes mellitus was 23% at one year increasing to 37% at 5 years after heart transplant [1]. Posttransplant diabetes mellitus (PTDM) has been associated with increased rates of serious infection [2, 3], graft-related complications such as graft rejection and graft loss [4], and reduced long-term survival compared to nondiabetic recipients [1]. The International Society of Heart and Lung Transplantation has recommended that routine screening for PTDM be performed with appropriate protocols in place for subsequent treatment [5]. The majority of studies that have examined treatment of PTDM have been conducted in renal transplant recipients; management strategies for PTDM after renal transplantation may not be appropriate for heart transplant recipients. There exists a significant need for prospective trials in this area, as PTDM continues to become an increasingly important issue in the transplant setting
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