Early post-transplant hyperglycemia and post-transplant diabetes mellitus following heart transplantation

ABSTRACT

Introduction

Heart transplantation is an important treatment for end-stage heart failure. Early post-transplant hyperglycemia (EPTH) and post-transplant diabetes mellitus (PTDM) are common following heart transplantation and are associated with increased morbidity and mortality.

Areas covered

This review summarizes the clinical characteristics, diagnosis, and treatment of EPTH and PTDM in cardiac transplant patients, incorporating findings from non-cardiac solid organ transplant studies where relevant due to limited heart-specific research.

Expert opinion

EPTH following heart transplantation is common yet understudied and is associated with the later development of PTDM. PTDM is associated with adverse outcomes including infection, renal dysfunction, microvascular disease, and an increased risk of re-transplantation and mortality. Risk factors for EPTH include the post-operative immunosuppression regimen, recipient and donor age, body mass index, infections, and chronic inflammation. Early insulin treatment is recommended for EPTH, whereas PTDM management is varied and includes lifestyle modification, anti-glycemic agents, and insulin. Given the emerging evidence on the transplant benefits associated with effective glucose control, and the cardioprotective potential of newer anti-glycemic agents, further focus on the management of EPTH and PTDM within heart transplant recipients is imperative.

KEYWORDS:

• Post-transplant diabetes mellitus
• hyperglycemia
• heart transplantation
• solid-organ transplantation
• transplant-related outcomes

Article highlights

• Heart transplant recipients have a high incidence of early post-transplant hyperglycemia (EPTH) and post-transplant diabetes mellitus (PTDM).

• Factors associated with EPTH include immunosuppression, age, family history, body mass index, infection, and inflammation. EPTH is strongly associated with the later development of PTDM.

• EPTH and PTDM are associated with numerous adverse transplant-related outcomes, including infection, renal dysfunction, microvascular disease, and mortality.

• Recommended treatment of EPTH is with insulin, whereas PTDM can be treated using a combination of lifestyle modification, non-insulin anti-glycemic agents, and lastly insulin.

• More research is needed into the clinical significance and treatment of EPTH, which has been historically neglected and understudied. EPTH is likely to be especially important in heart transplant patients who may have increased vulnerability to the negative health effects associated with hyperglycemia.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.