Temporal Changes on the Risks and Complications of Posttransplantion Diabetes Mellitus Following Cardiac Transplantation.

Nadia Iannino,Anique Ducharme,Normand Racine,Simon De Denus,Agnès Räkel,Annik Fortier,Amine Nasri,Maxime Tremblay-Gravel,Kim Lachance,Michel White

doi:10.1155/2018/9205083

Abstract

Background Recent changes in the demographic of cardiac donors and recipients have modulated the rate and risk, associated with posttransplant diabetes mellitus (PTDM). We investigated the secular trends of the risk of PTDM at 1 year and 3 years after transplantation over 30 years and explored its effect on major outcomes. Methods Three hundred and three nondiabetic patients were followed for a minimum of 36 months, after a first cardiac transplantation performed between 1983 and 2011. Based on the year of their transplantation, the patients were divided into 3 eras: (1983-1992 [era 1], 1993-2002 [era 2], and 2003-2011 [era 3]). Results In eras 1, 2, and 3, the proportions of patients with PTDM at 1 versus 3 years were 23% versus 39%, 21% versus 26%, and 33% versus 38%, respectively. Independent risk factors predicting PTDM at one year were recipient's age, duration of cold ischemic time, treatment with furosemide, and tacrolimus. There was a trend for overall survival being worse for patients with PTDM in comparison to patients without PTDM (p = 0.08). Patients with PTDM exhibited a significantly higher rate of renal failure over a median follow-up of 10 years (p = 0.03). Conclusion The development of PTDM following cardiac transplantation approaches 40% at 3 years and has not significantly changed over thirty years. The presence of PTDM is weakly associated with an increased mortality and is significantly associated with a worsening in renal function long-term following cardiac transplantation.

Highlights

Posttransplantation diabetes mellitus (PTDM), formerly called new-onset diabetes after transplant (NODAT), refers to the development of diabetes in previously nondiabetic patients, excluding transient hyperglycemia [1, 2]
The diagnosis of posttransplant diabetes was based on the initiation of hypoglycemic drugs including insulin, a fasting blood glucose ≥7 mmol/L, and/or HBA1C ≥6.5% at least once within 12 and 36 months following discharge from Cardiac transplant CVD (CTx)
Our study population consisted of 303 nondiabetic patients prior to transplantation discharged alive after surgery (Figure 1)

Summary

Introduction

Posttransplantation diabetes mellitus (PTDM), formerly called new-onset diabetes after transplant (NODAT), refers to the development of diabetes in previously nondiabetic patients, excluding transient hyperglycemia [1, 2]. The risk factors for PTDM are well established and include both general factors such as an increase in recipient age, the presence of obesity, African and Hispanic ethnicity, family history of diabetes, prediabetes prior to transplantation, as well as some transplant-specific factors such as immunosuppressive regimens including glucocorticoids, and the use of calcineurin inhibitors and/or mammalian target of rapamycin inhibitors [7,8,9,10] In these patients, PTDM impaired longterm graft function and survival, reduced long-term overall survival, and increased the risk of mortality and morbidity associated with cardiovascular disease [11, 12]. The presence of PTDM is weakly associated with an increased mortality and is significantly associated with a worsening in renal function long-term following cardiac transplantation

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