Uncomplicated Diabetes Doesn't Shorten Posttransplant Survival, Suggest UNOS Data

November 07, 2006

November 7, 2006 (Dallas, TX) – Diabetes by itself doesn't shorten postcardiac transplantation survival and so shouldn't necessarily disqualify a patient from being on a wait list. But diabetes-related complications such as renal insufficiency or stroke raise the postoperative risk of death and--given the short supply of donor hearts--could make a patient a less-appropriate transplant candidate.

So concluded Dr Mark J Russo (Columbia University College of Physicians and Surgeons, New York, NY) and colleagues from data compiled by the United Network for Organ Sharing (UNOS), which showed an inverse relationship between the severity of any preoperative diabetes-related end-organ damage and posttransplantation survival. Their analysis is published online in Circulation November 6, 2006 and is scheduled for the journal's November 21 issue.

Clinicians at every cardiac transplantation center struggle with decisions to accept or disqualify potential recipients when a donor heart becomes available, explained coauthor Dr Yoshifumi Naka (Columbia University College of Physicians and Surgeons) to heartwire . Although the criteria used to select or disqualify patients can vary at different centers, every decision is made on a case-by-case basis. Diabetes per se shouldn't prohibit someone from getting a heart, Naka said, but with complications, the picture is less clear-cut; the current data may help clinicians determine when a diabetic patient is or isn't an appropriate transplant candidate.

He and his colleagues stratified nearly 20 000 patients who underwent a first-time heart transplantation over a recent 11-year period according to their preoperative diabetic status and history of diabetes-related complications, including cerebrovascular events, peripheral vascular disease, renal failure, and severe obesity, defined as a body-mass index >35 kg/m2. About 18% of the cohort were confirmed to have diabetes, which, compared with not having diabetes, shaved about one year off the median posttransplant survival (p<0.001). But patients with uncomplicated diabetes fared as well as nondiabetics.

Median posttransplantation survival by diabetes status and complication severity

End point

No diabetes, n=15 826

Diabetes, n=3687

0 DRC

1 DRC

>2 DRCs

Median survival (y)

10.1

9.0

9.3

6.7

3.6

DRC=pretransplant diabetes-related complication. All differences vs no diabetes, p<0.001, except 0 DRCs vs no diabetes, p<0.08.

No consistent significant relationships were seen between diabetes and either rejection or coronary disease after transplantation. But the postoperative risk of infection was increased among diabetics (p<0.001) and climbed with the number of diabetes-related complications.

Potential heart-transplant candidates with diabetic complications that keep them off the traditional wait list could ultimately be treated with LV-assist devices as destination therapy or, observed Naka, at some centers they might go on an alternate "high-risk" wait list. Alternate-listed patients, he said, can become eligible for hearts judged unacceptable by patients on the standard wait list due to donor characteristics, such as advanced age, that render them less than ideal for transplantation.

1. Russo MJ, Chen JM, Hong KN, et al. Survival after heart transplantation is not diminished among recipients with uncomplicated diabetes mellitus. An analysis of the united network of organ sharing database. Circulation 2006; DOI: 10.1161/CIRCULATIONAHA.106.615708. Available at: http://circ.ahajournals.org .

The complete contents of Heartwire , a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.

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