Hyperglycemia is associated with infection and rejection in post-solid organ transplant (Tx) patients (pts), but little is known about peak insulin requirements and morbidity. We previously reported an unexpected finding in a retrospective cohort study of 207 liver Tx pts that evaluated the relationship to peak IV insulin requirements and subsequent morbidity. Pts were separated into quartiles (Q) by peak insulin drip rate [U/hr]. In that study, pts in Q4 of insulin requirements had significantly reduced infections out to 6 months post-Tx compared to Q1-3.
In the present study, we sought to replicate these findings in 188 heart Tx pts. Peak drip rate Qs are shown in the Figure below. Compared to Q1-3, Q4 pts were similar in age (53 ± 10.7 vs. 50.3 ± 9.4) and BMI (30.4 ± 6.4 vs. 29.2 ± 6.8), but more had DM (42.6% vs. 38.3%, p=0.003). Q4 pts had significantly fewer infections (19.1% vs. 53.9%, p<0.000001) up to 6 mos but similar rejections (4.3% vs. 11.3%, p=0.15). Also, we showed that avg blood glucose levels were not significantly different between Q1-3 and Q4 (p = 1.03).
These data in heart Tx pts confirm our findings in liver Tx pts that pts requiring higher insulin doses for glycemic control have decreased infections out to 6 months post Tx. We hypothesize that pts able to mount a greater counterregulatory hormone response to surgery may be healthier and able to better respond to infection. Alternatively, higher insulin doses could be protective.
G. Upadrasta: None. S.J. Kumar: None. A. Wallia: Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc., UnitedHealth Group. M. Molitch: Advisory Panel; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Pfizer Inc. Consultant; Self; AstraZeneca. Research Support; Self; Novartis Pharmaceuticals Corporation, Novo Nordisk Inc.