Study On Risk Factors For New Onset Diabetes Mellitus Post Orthotopic Heart Transplant (PTDM) And The Relationship Between PTDM And Long-term Survival

Objective:The objective of this study was to determine,in our experience,the incidence and presence of risk factors for new onset diabetes mellitus post orthotopic heart transplant(PTDM),and the relationship between PTDM and long time survival after heart transplantation(HT).Method:We studied 92 non-DM patients who underwent orthotopic heart transplantation in our hospital from September 2000 to December 2006 and had follow-up regularly,According to the diagnostic criteria of PTDM,they were divided into two groups.Analyze all variables that could be related to the development of PTDM during follow-up and then 1.Determine the incidence and presence of risk factors for PTDM in our experience,demonstrate the fasting blood glucose level after heart transplantation.2.Student t-test,Wilcoxon rank sum test andχ~2 test were used for univariate statistical analysis and logistic regression for multivariate analysis.3. Determine the relationship between PTDM and long time survival after heart transplantation.Kaplan-Meier method and log rank test were used for survival analysis.Results:1.Of the 92 patients,19 developed DM(20.65%) during a mean follow-up of 31 months.Student t-test revealed that mean fasting blood glucose value after transplantation was higher than pre-transplant(5.52±1.07,4.95±0.64,P＜0.001).2. The univariate analysis showed that patients developing PTDM are older(OR=1.06, P=0.01),have a higher body mass index(BMI)(OR=1.07,P=0.02),a higher mean fasting blood glucose value(OR=7.24,P＜0.001),a higher frequency of rejection episodes(OR=3.28,P=0.05),and a higher family history of DM(OR= 3.99,P=0.04).Multivariate analysis identified the following as predictive factors for the development of PTDM:age(OR=1.09,P=0.03),body mass index(BMI) (OR=1.45,P=0.007),family history of DM(OR=7.97,P=0.038),fasting blood glucose value before operation(OR=5.83,P=0.003).3.The rejection rate of patients with PTDM was higher than that of patients without PTDM(31.58%versus 12.33%,P=0.04). The overall infection rate was similar(P=0.80).Overall patient survival at one,three and 5-yr post transplant was 96.29,88.80%,80.62%.PTDM patients survival at one, three and 5-yr post transplant was 87.50%,72.92%,72.92%.NPTDM patients survival at one,three and 5-yr post transplant was 96.95%,93.44%,81.95%.which revealed that patients developing PTDM had the worse outcome(P=0.10).Conclusion:In our population,1.the incidence of new onset diabetes mellitus post orthotopic heart transplant is 20.65%during a mean follow-up of 31 months and is similar to that reported in literatures.Post-operative fasting blood glucose value is higher than that of pre-operative.2.Age,Pre-operative overweight especially body mass index(BMI),family history of DM,fasting blood glucose value were significant and independent risk factors for the development of PTDM during follow-up.3. PTDM appears to negatively influence the rejection rate after orthotopic heart transplantation.,and the difference of graft long-term survival and infection rate did not reach statistical significance in our follow-up.