Incidence, Risk Factors and Clinical Implications of Glucose Metabolic Changes after Heart Transplant
Diabetes mellitus (DM) arising <i>de novo</i> after transplant is a common complication, sharing many features with type 2 DM but also specific causes, such as administration of steroids and immunosuppressive drugs. Although post-transplant DM (PTDM) is generally assumed to worsen recipi...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-10-01
|
| Series: | Biomedicines |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9059/10/11/2704 |
| _version_ | 1797469034092953600 |
|---|---|
| author | Emanuele Durante-Mangoni Domenico Iossa Valeria Iorio Irene Mattucci Umberto Malgeri Daniela Pinto Roberto Andini Ciro Maiello Rosa Zampino |
| author_facet | Emanuele Durante-Mangoni Domenico Iossa Valeria Iorio Irene Mattucci Umberto Malgeri Daniela Pinto Roberto Andini Ciro Maiello Rosa Zampino |
| author_sort | Emanuele Durante-Mangoni |
| collection | DOAJ |
| description | Diabetes mellitus (DM) arising <i>de novo</i> after transplant is a common complication, sharing many features with type 2 DM but also specific causes, such as administration of steroids and immunosuppressive drugs. Although post-transplant DM (PTDM) is generally assumed to worsen recipients’ outcomes, its impact on renal function, cardiac allograft vasculopathy and mortality remains understudied in heart transplant (HT). We evaluated incidence and risk factors of PTDM and studied glucose metabolic alterations in relation to major HT outcomes. 119 subjects were included in this retrospective, single centre, observational study. A comprehensive assessment of glucose metabolic state was done pre-transplant and a median of 60 months [IQR 30–72] after transplant. Most patients were males (75.6%), with prior non-ischemic cardiomyopathy (64.7%) and median age of 58 years [IQR 48–63]. 14 patients developed PTDM, an incidence of 3.2 cases/100 patient-years. Patients with worsening glucose metabolic pattern were the only who showed a significant increase of BMI and metabolic syndrome prevalence after transplant. 23 (19.3%) patients died during follow up. Early mortality was lower in those with stably normal glucose metabolism, whereas improvement of glucose metabolic state favorably affected mid-term mortality (log-rank <i>p</i> = 0.028). No differences were observed regarding risk of infections and cancer. PTDM is common, but glucose metabolism may also improve after HT. PTDM is strictly related with BMI increase and metabolic syndrome development and may impact recipient survival. |
| first_indexed | 2024-03-09T19:15:43Z |
| format | Article |
| id | doaj.art-f94a22cb1e5b43949f8217ee1d993868 |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-09T19:15:43Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-f94a22cb1e5b43949f8217ee1d9938682023-11-24T03:49:21ZengMDPI AGBiomedicines2227-90592022-10-011011270410.3390/biomedicines10112704Incidence, Risk Factors and Clinical Implications of Glucose Metabolic Changes after Heart TransplantEmanuele Durante-Mangoni0Domenico Iossa1Valeria Iorio2Irene Mattucci3Umberto Malgeri4Daniela Pinto5Roberto Andini6Ciro Maiello7Rosa Zampino8Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri Snc, 80131 Naples, ItalyUnit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri Snc, 80131 Naples, ItalyUnit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri Snc, 80131 Naples, ItalyUnit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri Snc, 80131 Naples, ItalyUnit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri Snc, 80131 Naples, ItalyUnit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri Snc, 80131 Naples, ItalyUnit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri Snc, 80131 Naples, ItalyUnit of Heart Transplant, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, ItalyUnit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri Snc, 80131 Naples, ItalyDiabetes mellitus (DM) arising <i>de novo</i> after transplant is a common complication, sharing many features with type 2 DM but also specific causes, such as administration of steroids and immunosuppressive drugs. Although post-transplant DM (PTDM) is generally assumed to worsen recipients’ outcomes, its impact on renal function, cardiac allograft vasculopathy and mortality remains understudied in heart transplant (HT). We evaluated incidence and risk factors of PTDM and studied glucose metabolic alterations in relation to major HT outcomes. 119 subjects were included in this retrospective, single centre, observational study. A comprehensive assessment of glucose metabolic state was done pre-transplant and a median of 60 months [IQR 30–72] after transplant. Most patients were males (75.6%), with prior non-ischemic cardiomyopathy (64.7%) and median age of 58 years [IQR 48–63]. 14 patients developed PTDM, an incidence of 3.2 cases/100 patient-years. Patients with worsening glucose metabolic pattern were the only who showed a significant increase of BMI and metabolic syndrome prevalence after transplant. 23 (19.3%) patients died during follow up. Early mortality was lower in those with stably normal glucose metabolism, whereas improvement of glucose metabolic state favorably affected mid-term mortality (log-rank <i>p</i> = 0.028). No differences were observed regarding risk of infections and cancer. PTDM is common, but glucose metabolism may also improve after HT. PTDM is strictly related with BMI increase and metabolic syndrome development and may impact recipient survival.https://www.mdpi.com/2227-9059/10/11/2704diabetes mellitustransplantcomplicationsmortalityoutcomeglucose metabolism |
| spellingShingle | Emanuele Durante-Mangoni Domenico Iossa Valeria Iorio Irene Mattucci Umberto Malgeri Daniela Pinto Roberto Andini Ciro Maiello Rosa Zampino Incidence, Risk Factors and Clinical Implications of Glucose Metabolic Changes after Heart Transplant Biomedicines diabetes mellitus transplant complications mortality outcome glucose metabolism |
| title | Incidence, Risk Factors and Clinical Implications of Glucose Metabolic Changes after Heart Transplant |
| title_full | Incidence, Risk Factors and Clinical Implications of Glucose Metabolic Changes after Heart Transplant |
| title_fullStr | Incidence, Risk Factors and Clinical Implications of Glucose Metabolic Changes after Heart Transplant |
| title_full_unstemmed | Incidence, Risk Factors and Clinical Implications of Glucose Metabolic Changes after Heart Transplant |
| title_short | Incidence, Risk Factors and Clinical Implications of Glucose Metabolic Changes after Heart Transplant |
| title_sort | incidence risk factors and clinical implications of glucose metabolic changes after heart transplant |
| topic | diabetes mellitus transplant complications mortality outcome glucose metabolism |
| url | https://www.mdpi.com/2227-9059/10/11/2704 |
| work_keys_str_mv | AT emanueledurantemangoni incidenceriskfactorsandclinicalimplicationsofglucosemetabolicchangesafterhearttransplant AT domenicoiossa incidenceriskfactorsandclinicalimplicationsofglucosemetabolicchangesafterhearttransplant AT valeriaiorio incidenceriskfactorsandclinicalimplicationsofglucosemetabolicchangesafterhearttransplant AT irenemattucci incidenceriskfactorsandclinicalimplicationsofglucosemetabolicchangesafterhearttransplant AT umbertomalgeri incidenceriskfactorsandclinicalimplicationsofglucosemetabolicchangesafterhearttransplant AT danielapinto incidenceriskfactorsandclinicalimplicationsofglucosemetabolicchangesafterhearttransplant AT robertoandini incidenceriskfactorsandclinicalimplicationsofglucosemetabolicchangesafterhearttransplant AT ciromaiello incidenceriskfactorsandclinicalimplicationsofglucosemetabolicchangesafterhearttransplant AT rosazampino incidenceriskfactorsandclinicalimplicationsofglucosemetabolicchangesafterhearttransplant |