Cardiac transplantation in patients with insulin-treated diabetes mellitus[*]

Summary:

Background and methods: As documented earlier the incidence of cardiac mortality in diabetic patients due to coronary artery disease is high. Cardiac transplantation for congestive heart failure due to coronary artery disease, cardiomyopathy, and valvular diseases is obviously a therapeutic option in patients suffering from insulin-treated diabetes mellitus. To shed more light on this problem we performed a retrospective analysis of 40 patients with insulin-treated diabetes mellitus (three type-1; 37 type-2; insulin-treated for at least three months before cardiac transplantation ) referred to our transplant unit for cardiac transplantation between March 1989 and December 1996.

Results: Orthotopic cardiac transplantation was performed in 40 patients (4 women, 36 men) aged 32-73 years (mean 56 years) with an insulin-treated diabetes mellitus preexisting for 3-348 months (mean 65.1 months). Donor age ranged from 15 to 72 years (mean 35.5 years) matched for body weight and blood group. Overall mortality in this group was 40,0% with an early mortality of 12,5%.

Conclusions: Our results show that type-1/2 insulin-treated diabetes mellitus preoperative to heart transplantation is not a contraindication in patients suffering from end-stage heart failure. Adequate therapy of diabetes mellitus as well as individual immunosuppressive therapy are important in order to minimize additional organ damage caused by the drugs themselves or resulting infectious complications.

Abbreviations: Aza: azathioprine, AVR: aortic valve replacement, CAD: coronary artery disease, CCT: craniocerebral trauma, CyA: cyclosporine A, DCM: dilated cardiomyopathy, DM: diabetes mellitus, HT: orthotopic heart transplantation, ICB: intracerebral bleeding, IHD: ischemic heart disease, ISHLT: International Society for Heart and Lung Transplantation, IST: immunosuppressive therapy, LVEDP: left ventricular enddiastolic pressure, LV-EF: left ventricular ejection fraction, MVR: mitral valve replacement, Pred: prednisone, SAB: subarachnoid bleeding

Key words:

Heart transplantation - insulin-treated diabetes mellitus type 1/2 - immunosuppression

1 * Grant support was given by the German Association of Organ Recipients (reg. ASS.)

References

• 1 Aleksic I, Czer L S, Freimark D, Dalichau H, Takkenberg J J, Blanche C, Nessim S, Nusser P, Trento A. Heart transplantation in patients with diabetic end-organ damage before transplantation.  Thorac Cardiovasc Surg. 44 282-288 1996; 
• 2 Badellino M M, Cavarocchi N C, Narins B, Jessup M, Alpern J B, McClurken J B, Shuman C R. Cardiac transplantation in diabetic patients.  Transplant Proc. 22 2384-2388 1990; 
• 3 Faglia E, Favales F, Mazzola E, Pizzi G, De Maria R, Mangiavacchi M, Gronda E, Caroli A, Zaina M S. Heart transplantation in mildly diabetic patients.  Diabetes. 39 740-742 1990; 
• 4 Griepp R B. A decade of human heart transplantation.  Transplant Proc. 11 285-292 1979; 
• 5 Koerner M M, Posival H, Tenderich G, El-Banayosy A, Koertke H, zu Knyphausen E, Kleesiek K, Meyer H, Koerfer R. Long-term results with cyclosporine monotherapy after heart transplantation.  Transplant Proc. 26 2718-2720 1994; 
• 6 Landowski J S, Kormos R L, Uretsky B F, Griffith B F, Armitage J M, Hardesty R L. Heart transplantation in diabetic recipients.  Transplantation. 49 303-305 1990; 
• 7 Livi U, Bortolotti U, Faggian G, Chiominto B, Mazzucco A, Galucci V. Safety of cyclosporine monotherapy after heart transplantation.  Transplant Proc. 22 1441-1442 1990; 
• 8 Livi U, Caforio A L, Grassi G, Boffa G M, Gambino A, Milano A, Bianco R, Casula R, Thiene G, Casarotto D. Mid-term results of heart transplantation in diabetic patients.  J Cardiovasc Surg 35 ((Suppl 1)) 115-118 1994a; 
• 9 Livi U, Luciani G B, Boffa G M, Faggian G, Bortolotti U, Thiene G, Mazzucco A. Clinical results of steroid-free induction immunosuppression after heart transplantation.  Ann Thorac Surg. 55 1160-1165 1993; 
• 10 Livi U, Milano A, Bortolotti U, Casula R, Zenati M, Casarotto D. Results of heart transplantation by extending recipient selection criteria.  J Cardiovasc Surg. 35 377-382 1994b; 
• 11 Lower R R, Szentpetery S, Quinn J, Thomas F T. Selection of patients for cardiac transplantation.  Transplant Proc. 11 293-295 1979; 
• 12 Munoz E, Lonquist J L, Radovancevic B, Baldwin R T, Ford S, Duncan J M, Frazier O H. Long-term results in diabetic patients undergoing heart transplantation.  J Heart Lung Transplant. 11 943-949 1992; 
• 13 Rhenman M J, Rhenman B, Icenogle T, Christensen R, Copeland J. Diabetes and heart transplantation.  J Heart Transplant. 7 356-358 1988; 
• 14 Toledo-Pereyra L H, Zeichner W D, Baskin S, McNichol L, Lin W, Thavarajah K, Whitten J. Predictive survival after kidney transplantation - an analysis of risk factors.  Am Surg. 49 632-636 1983; 
• 15 Yacoub M, Alivizatos P, Khagani A, Mitchell A. The use of cyclosporine azathioprine and antihymocite globuline with or without low dose steroids for immunosuppression of cardiac transplant patients.  Transplant Proc. 17 221-212 1985; 

1 * Grant support was given by the German Association of Organ Recipients (reg. ASS.)