Mg. Nieuwenhuis et Jh. Kirkels, Predictability and other aspects of post-transplant diabetes mellitus in heart transplant recipients, J HEART LUN, 20(7), 2001, pp. 703-708
Background: Diabetes mellitus that develops after organ transplantation may
predispose patients to further complications. We studied the value of pre-
transplant oral glucose tolerance testing or maximum random plasma glucose,
and HLA-DR3 and/or DR4 phenotype as predictors of post-transplantation dia
betes mellitus in heart transplant recipients.
Patients and Methods: In 228 cardiac allograft recipients (median age, 50 y
ears; mean follow-up, 4.77 years), we used either pre-transplant oral gluco
se tolerance testing results (Group I, n = 141)-excluding patients with pre
-existing diabetes (n = 9)-or maximum random plasma glucose values (Group I
I, n = 78) to study predictability of post-transplant diabetes. In addition
, we investigated its relation to rejection treatment and clinical course.
Results: Cumulative incidence of post-transplant diabetes (n = 43) was 19.6
%, 83% of which became manifest within 3 months post-transplant; pre-transp
lant body mass index was higher (p < 0.01) in this group. Mortality did not
increase. Of 123 patients in Group I who survived > 3 months, post-transpl
ant diabetes occurred in 32% vs 16% of those with impaired and normal gluco
se tolerance respectively (ns), and in 55% of patients with isolated post-l
oad hyperglycemia (p < 0.05 vs normal). Maximum random glucose values (Grou
p II) did not predict post-transplant diabetes. Prevalence of the HLA-DR3,
DR4, and DR3DR4 phenotypes did not increase in post-transplant diabetes; re
lation to rejection treatment was likely in 30%. Approximately 50% of post-
transplant diabetes patients required only temporary drug treatment.
Conclusions: The risk of post-transplant diabetes increased parallel to pre
-transplant degree of glucose intolerance, but was considerable even in nor
mal glucose tolerance. HLA-DR3 and/or DR4 phenotype was not a predisposing
factor.