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(Circulation. 2006;114:2280-2287.)
© 2006 American Heart Association, Inc.

Transplantation

Survival After Heart Transplantation Is Not Diminished Among Recipients With Uncomplicated Diabetes Mellitus

An Analysis of the United Network of Organ Sharing Database

Mark J. Russo, MD, MS; Jonathan M. Chen, MD; Kimberly N. Hong, MHSA; Allan S. Stewart, MD; Deborah D. Ascheim, MD; Michael Argenziano, MD; Donna M. Mancini, MD; Mehmet C. Oz, MD; Yoshifumi Naka, MD, PhD; the Columbia University Heart Transplant Outcomes Research Group

From the Division of Cardiothoracic Surgery, Department of Surgery (M.J.R., J.M.C., K.N.H., A.S.S., M.A., M.C.O., Y.N.) and Division of Cardiology, Department of Medicine (D.D.A., D.M.M.), College of Physicians and Surgeons, and the International Center for Health Outcomes and Innovation Research (InCHOIR; M.J.R., D.D.A.); Columbia University New York, NY.

Correspondence to Yoshifumi Naka, MD, PhD, New York-Presbyterian Hospital/Columbia, Milstein Hospital Bldg, Room 7-435 GN, 177 Fort Washington Ave, New York, NY 10032. E-mail yn33{at}columbia.edu

Received January 23, 2006; revision received July 28, 2006; accepted August 22, 2006.

Background— This study compares posttransplantation outcomes of survival and morbidity among recipients with and without diabetes mellitus (DM).

Methods and Results— The United Network of Organ Sharing (UNOS) provided deidentified patient-level data. Primary analysis focused on 20 412 first-time heart transplant recipients aged 18 years who underwent transplantation between January 1, 1995, and December 31, 2005. To determine severity of DM, DM recipients were stratified by their aggregate number of diabetes-related complications (DRCs), including pretransplantation history of renal failure (serum creatinine=2.5 mg/dL), peripheral vascular disease, cerebrovascular accident, and severe obesity (body mass index 35 kg/m²). Kaplan-Meier analysis was performed to compare time to event. Although posttransplantation survival was significantly better (P<0.001) among patients without DM (median survival 10.1 years) than among those with DM (9.0 years), survival did not differ (P=0.08) between those without DM (10.1 years) and those with uncomplicated DM (0 DRCs; 9.3 years). Among those with DM, survival was worse with each additional DRC: 0 DRC, 9.3 years; 1 DRC, 6.7 years; and 2 DRCs, 3.6 years. Although acute rejection and transplant coronary artery disease–free survival did not differ between groups, renal failure and severe infection-free survival were worse in those with DM and were inversely related to the number of DRCs.

Conclusions— Posttransplantation survival among patients with uncomplicated DM was not significantly different than that among nondiabetics. However, when stratified by disease severity, recipients with more severe diabetes had significantly worse survival than nondiabetics. Therefore, although DM alone should not be a contraindication to heart transplantation, given the critical shortage of transplantable organs, maximal benefit may be achieved by exploring alternative treatment options in patients with severe DM. These include use of high-risk transplant lists and destination therapy.

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