Wait List And Transplant Outcomes Of Diabetic Patients With Listed For Heart Transplantation: A Propensity-matched Analysis

Abstract

<h3>Background</h3> We investigated the current trends and outcomes of diabetic patients listed for heart transplants in the U.S. and provided a method for risk-stratification. <h3>Methods</h3> Using data from the United Network for Organ Sharing (UNOS), we identified heart failure patients listed for heart transplants between 2010 and 2019. Diabetic patients were propensity-matched with non-diabetics, and waitlist mortality as well as post-transplant graft survival were compared between the two groups. Further risk-stratification of diabetic patients was done based on the risk factors that independently predict graft failure. <h3>Results</h3> 28,928 adult patients (30% diabetic) with end-stage heart failure were added to the waitlist over the study period. In the propensity-matched cohort, waitlist mortality was higher in diabetic patients compared to non-diabetics (HR=1.13 (95% CI=1.04-1.22, p=0.002). Over the study period, 5739 patients with diabetes were transplanted. In the propensity-matched cohorts of transplant recipients, the rate of graft failure was significantly higher for diabetic patients (23.3%) compared to non-diabetics (20.4%); HR=1.17, 95% CI=1.08-1.26, p<0.001. We identified 12 risk factors of graft failure among diabetic patients and developed a risk score that further risk-stratify these patients. Diabetic patients at low risk (score≤4) had similar graft survival as patients without diabetes (HR=0.91, 95% CI=0.82-1.01, p=0.06). On the other hand, high-risk diabetic patients had worse graft survival compared to non-diabetics (HR=1.52, 95% CI=1.38-1.67, P<0.001). <h3>Conclusion</h3> Among patients with end-stage heart failure, pre-existing diabetes was associated with higher waitlist mortality and worse graft survival. However, with careful patient selection, graft survival is similar to those without diabetes.