AUTHOR=Rivinius Rasmus , Gralla Carolin , Helmschrott Matthias , Darche Fabrice F. , Ehlermann Philipp , Bruckner Tom , Sommer Wiebke , Warnecke Gregor , Kopf Stefan , Szendroedi Julia , Frey Norbert , Kihm Lars P. 

TITLE=Pre-transplant Type 2 Diabetes Mellitus Is Associated With Higher Graft Failure and Increased 5-Year Mortality After Heart Transplantation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.890359

DOI=10.3389/fcvm.2022.890359

ISSN=2297-055X

ABSTRACT=<sec><title>Aims</title><p>Cardiac transplant recipients often suffer from type 2 diabetes mellitus (T2DM) but its influence on graft failure and post-transplant mortality remains unknown. The aim of this study was to investigate the long-term effects of pre-transplant T2DM in patients after heart transplantation (HTX).</p></sec><sec><title>Methods</title><p>This study included a total of 376 adult patients who received HTX at Heidelberg Heart Center between 01/01/2000 and 01/10/2016. HTX recipients were stratified by diagnosis of T2DM at the time of HTX. Patients with T2DM were further subdivided by hemoglobin A1c (HbA1c ≥ 7.0%). Analysis included donor and recipient data, immunosuppressive drugs, concomitant medications, post-transplant mortality, and causes of death. Five-year post-transplant mortality was further assessed by multivariate analysis (Cox regression) and Kaplan–Meier estimator.</p></sec><sec><title>Results</title><p>About one-third of all HTX recipients had T2DM (121 of 376 [32.2%]). Patients with T2DM showed an increased 5-year post-transplant mortality (41.3% versus 29.8%; <italic>P</italic> = 0.027) and had a higher percentage of death due to graft failure (14.9% versus 7.8%; <italic>P</italic> = 0.035). Multivariate analysis showed T2DM (HR: 1.563; 95% CI: 1.053–2.319; <italic>P</italic> = 0.027) as an independent risk factor for 5-year mortality after HTX. Kaplan–Meier analysis showed a significantly better 5-year post-transplant survival of patients with T2DM and a HbA1c &lt; 7.0% than patients with T2DM and a HbA1c ≥ 7.0% (68.7% versus 46.3%; <italic>P</italic> = 0.008) emphasizing the clinical relevance of a well-controlled T2DM in HTX recipients.</p></sec><sec><title>Conclusion</title><p>Pre-transplant T2DM is associated with higher graft failure and increased 5-year mortality after HTX.</p></sec>