Background New-onset diabetes (NODM) and glucose intolerance (GI) are among the most serious known metabolic complications following heart transplantation, with a reported incidence ranging up to 53%. The impact of specific calcineurin inhibitor on these complications is yet to be determined. This study aimed to investigate the factors leading to the development of NODM in a large cohort of patients undergoing cardiac transplantation.
Methods We reviewed baseline characteristics and outcomes data in 455 patients between January 1994 and December 2003 who underwent cardiac transplantation at a single center. GI (defined as fasting glucose > 100 mg/dL and < 126 mg/dL on no diabetic therapy) and diabetes (fasting glucose > 126 mg/dL ×2 or oral and/or insulin treatment) were evaluated pre- and post-transplant.
Results We analyzed a subset of patients (n = 371) of whom, prior to transplant, 250 (67.4%) had normal blood glucose values, 25 (6.7%) had glucose intolerance, and 96 (25.9%) were diabetic. Following transplantation, 140 patients were diagnosed with GI and 104 with NODM. This led to an overall incidence of post-transplant GI and NODM of 77.1% (GI 31.0%, NODM 46.1%). From multivariate analysis, risk factors for NODM included GI (p [log-rank] = .06; p [Wilcoxon] = .05) and recipient history of hypertension (p = .02). NODM and nondiabetics were similar in age, sex, race, creatinine, hyperlipidemia, and immunosuppression regimen. Between tacrolimus- and cyclosporine-treated patients, there was no difference in the incidence of GI (31.5% vs 34.7%, p = .70) and NODM (34.9% vs 24.9%, p = .19).
Conclusion A vast majority of patients after heart transplant are either GI or diabetic with no significant difference between tacrolimus or cyclosporine therapy. Pretransplant glucose intolerance was associated with increasing development of NODM. More aggressive glucose control after transplant may prevent long-term complications.
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