Cardiac transplantation in patients with insulin-treated diabetes mellitus

Background and methods: As documented earlier the incidence of cardiac mort ality 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 i n patients suffering from insulin-treated diabetes mellitus. To shed more l ight on this problem we performed a retrospective analysis of 40 patients w ith insulin-treated diabetes mellitus (three type-1; 37 type-2; insulin-tre ated for at least three months before cardiac transplantation) referred to our transplant unit for cardiac transplantation between March 1989 and Dece mber 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 di abetes 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 bl ood group. Overall mortality in this group was 40,0% with an early mortalit y of 12,5%. Conclusions: Our results show that type-1/2 insulin-treated diabetes mellit us preoperative to heart transplantation is not a contraindication in patie nts suffering from end-stage heart failure. Adequate therapy of diabetes me llitus as well as individual immunosuppressive therapy are important in ord er to minimize additional organ damage caused by the drugs themselves or re sulting infectious complications. Abbreviations: Aza: azathioprine, AVR: aortic valve replacement, CAD: coron ary artery disease, CCT: craniocerebral trauma, CyA: cyclosporine A, DCM: d ilated cardiomyopathy, DM: diabetes mellitus, HT: orthotopic heart transpla ntation, ICE: intracerebral breeding, IHD: ischemic heart disease, ISHLT: I nternational Society for Heart and Lung Transplantation, IST: immunosuppres sive therapy, LVEDP: left ventricular enddiastolic pressure, LV-EF: left ve ntricular ejection fraction, MVR: mitral valve replacement, Pred: prednison e, SAB: subarachnoid bleeding.