Increased morbidity in diabetic cardiac transplant recipients

BACKGROUND: Diabetes currently affects more than 7% of the Canadian population, and heart failure is a well-documented complication of diabetes. The medical management of heart failure is often limited by disease progression, and cardiac transplantation is a key therapeutic option in end-stage disease. However, both American and Canadian guidelines continue to list diabetes as a relative contraindication to cardiac transplantation. OBJECTIVE: To determine the effect of preoperative diabetes on morbidity and mortality in patients undergoing cardiac transplantation. METHODS: A retrospective analysis of 136 adult patients undergoing cardiac transplantation at the London Health Sciences Centre (London, Ontario) between February 1995 and November 2003 was performed. Preoperatively, 14% of patients were diabetic. Unpaired Student's t tests and x(2) tests were used to compare outcomes between diabetic and nondiabetic cardiac transplant recipients. RESULTS: Diabetic and nondiabetic cardiac transplant recipients were similar in age, sex, body mass index and ischemic time. Preoperatively, diabetic recipients had a higher mean serum glucose and an increased incidence of ischemic cardiomyopathy. At three years postcardiac transplantation, diabetic recipients were found to have increased rates of transplant coronary artery disease, as well as decreased cardiac function. However, diabetic and nondiabetic patients showed no differences in rates of clinically significant infection or rejection in the first three postoperative months. Furthermore, survival rates were similar between these two groups. CONCLUSION: Diabetes is not a contraindication to cardiac transplantation, but increased vigilance is warranted in this population to minimize postoperative morbidity.