Heart Transplantation in Mildly Diabetic Patients

From 1985 to 1989, 67 heart transplantations were performed in our hospital, 6 of them in non-insulin-dependent (type II) diabetic patients. Six pretransplantation type II diabetic male heart recipients (mean ± SD age 50.0 ± 7.3 yr) were compared with 61 nondiabetic recipients (mean age 44.5 ±11.0 yr; 55 men, 6 women) to define whether a different posttransplantation prognosis may be caused by pretransplantation diabetes. Before transplantation, all diabetic recipients (3 newly diagnosed and 3 with diabetes duration of 5, 6, and 12 yr, respectively) were in good glycemie control (mean fasting blood glucose 7.95 ± 1.62 mM, mean HbA_1c 7.6 ± 0.2%). None had ocular or renal microangiopathic complications, 5 were treated only with diet, and 1 was treated with oral hypoglycemic agents. All recipients were treated with the same immunosuppressive protocol (cyclosporin, prednisone, and since 1986, azathioprine and antilymphocyte globulin), and mean dose and blood levels of cyclosporin were not significantly different between diabetic and nondiabetic recipients. After heart transplantation (mean follow-up 558 ± 340 days in diabetic and 379 ± 338 in nondiabetic recipients), the mortality rate and complications (i.e., rejection episodes, supplementary immunosuppressive treatments, major and minor infections, arterial hypertension, and graft atherosclerosis) showed no significant differences except for the more frequent arterial hypertension in diabetic recipients (P < 0.05), although pretransplantation incidence of hypertension was lower in diabetic candidates. Even during immunosuppressive treatment, including corticosteroids, diabetic recipients had good metabolic control (mean fasting blood glucose 6.32 ± 1.96 mM, mean HbA_1c 5.3 ± 0.5% at the 6th mo). Three recipients were treated with insulin and/or oral hypoglycemic agents, and 1 recipient was treated with diet only. Serum cholesterol, triglycerides, and creatinine levels did not vary significantly between the two groups in posttransplantation follow-up. After heart transplantation, pretransplantation diabetic recipients in good metabolic control and without microangiopathic complications had the same prognosis in this series as nondiabetic recipients at this stage of follow-up.