BACKGROUND: The objectives of this study are to examine the incidence of new-onset diabetes mellitus (NODM) and to identify its risk factors in adult heart recipients using the Organ Procurement and Transplant Network/United Network of Organ Sharing database. METHODS: Between July 2004 and December 2007, 4972 adults (aged 18 years or older) received their first heart transplant alone, and had at least one follow-up report of posttransplant diabetic status. Among these, 3763 recipients were identified as not having diabetes mellitus pretransplant. Risk factors for NODM were examined using multivariate Cox regression analysis using the time to NODM diagnosis as a time-varying endpoint. RESULTS: NODM was reported in 1075 (28.6%) of the 3763 recipients without pretransplant diabetes (median follow-up time, 713 days). Independent risk factors for development of NODM included older age (hazard ratio=1.20 for age >or=50 years vs. <50, P=0. 01), non-white race (0.70 for white vs. non-white, P<0.0001), higher body mass index (BMI) (1.55 for BMI >or=25 vs. <25, P<0.0001), ischemic heart disease (1.24, P<0.0001), recipient cytomegalovirus positivity (1.16, P=0.003), tobacco use (1.16, P=0.02), tacrolimus use at discharge (1.85 for tacrolimus vs. cyclosporine use, P<0.0001), and use of steroids at discharge (2.59 for steroid use vs. none, P=0.008). CONCLUSIONS: NODM is common and occurs in more than a quarter of heart recipients during the median follow-up period of 2 years. Risk factors for NODM after heart transplant are similar to those reported in other solid organ transplants. Some of these factors, such as BMI and immunosuppressive regimen, are potentially modifiable.
BACKGROUND: The objectives of this study are to examine the incidence of new-onset diabetes mellitus (NODM) and to identify its risk factors in adult heart recipients using the Organ Procurement and Transplant Network/United Network of Organ Sharing database. METHODS: Between July 2004 and December 2007, 4972 adults (aged 18 years or older) received their first heart transplant alone, and had at least one follow-up report of posttransplant diabetic status. Among these, 3763 recipients were identified as not having diabetes mellitus pretransplant. Risk factors for NODM were examined using multivariate Cox regression analysis using the time to NODM diagnosis as a time-varying endpoint. RESULTS: NODM was reported in 1075 (28.6%) of the 3763 recipients without pretransplant diabetes (median follow-up time, 713 days). Independent risk factors for development of NODM included older age (hazard ratio=1.20 for age >or=50 years vs. <50, P=0. 01), non-white race (0.70 for white vs. non-white, P<0.0001), higher body mass index (BMI) (1.55 for BMI >or=25 vs. <25, P<0.0001), ischemic heart disease (1.24, P<0.0001), recipient cytomegalovirus positivity (1.16, P=0.003), tobacco use (1.16, P=0.02), tacrolimus use at discharge (1.85 for tacrolimus vs. cyclosporine use, P<0.0001), and use of steroids at discharge (2.59 for steroid use vs. none, P=0.008). CONCLUSIONS: NODM is common and occurs in more than a quarter of heart recipients during the median follow-up period of 2 years. Risk factors for NODM after heart transplant are similar to those reported in other solid organ transplants. Some of these factors, such as BMI and immunosuppressive regimen, are potentially modifiable.
Authors: Joshua D Chew; Jonathan H Soslow; Cary Thurm; Matt Hall; Debra A Dodd; Brian Feingold; Jill Simmons; Justin Godown Journal: Pediatr Cardiol Date: 2018-01-03 Impact factor: 1.655