HEART-TRANSPLANTATION IN PATIENTS WITH DIABETIC END-ORGAN DAMAGE BEFORE TRANSPLANTATION

Diabetes mellitus with preexisting end-organ damage (EOD) is considere d a contraindication for heart transplantation. The outcome of such pa tients has not been well characterized. Among 138 patients transplante d between 12/88 and 7/94, 29 were diabetic (11 insulin-dependent); of these, 12 had preexisting EOD, defined as a creatinine clearance less than or equal to 50 ml/min, a 24-hour urine protein concentration grea ter than or equal to 500 mg/L or typical symptoms of peripheral or aut onomic polyneuropathy, and 17 had no EOD. We compared diabetics with a nd without EOD and nondiabetics (n = 109) for operative mortality, len gth of stay, serum creatinine, fasting glucose levels, and postoperati ve prednisone doses at 1,6, and 12 months. Actuarial survival and free dom from rejection and infection were analyzed. Both diabetic groups w ere significantly older than nondiabetics. Ischemic time, operative mo rtality, surgical technique, ICU- and total length of stay were simila r. Actuarial survival and freedom from rejection were similar among th e three groups. Infection rates including CMV did not differ. Serum cr eatinine levels increased in all groups compared to pretransplant leve ls (p = 0.001), but without significant differences among the groups. Post-transplant glucose levels at 6 and 12 months were higher for diab etic patients with EOD than for those without or for nondiabetics (183 , 153, and 94 mg/dl at 6 months, p = 0.01; 202, 161, and 102 mg/dl at 12 months, p = 0.0001). Prednisone dosage was lower in diabetics with EOD at 6 months, but did not differ among the three groups at 12 month s. The incidence of angiographically proven transplant vasculopathy di d not differ at 1 and 2 years. Diabetics with preexisting EOD undergoi ng heart transplantation experience similar short- and intermediate-te rm results when compared to diabetics without EOD and nondiabetics. Me tabolic control is more difficult to achieve, as indicated by higher f asting glucose levels. Larger and longer-term prospective studies have to confirm our findings, since the shortage of donor organs would inc rease if such patients were transplanted routinely.