Risk Factors for New-Onset Diabetes Mellitus After Heart Transplantation: A Nomogram Approach |
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| Affiliation: | 1. Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. Huadong Hospital Affiliated to Fudan University, Shanghai, Shanghai, China;1. Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil;2. Laboratory of Medical Investigation 37 (LIM-37), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil;3. Kidney Transplantation Division, Department of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil;1. Department of Nephrology, University Hospital of Marburg, UKGM GmbH, Marburg, Germany;2. Department of Diagnostic and Interventional Radiology, University Hospital of Marburg, UKGM GmbH, Marburg, Germany;1. Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea;2. Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea;3. Division of Nephrology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea;4. Division of Nephrology, Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea;5. Division of Kidney and Pancreas Transplantation, Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea;6. Division of Kidney and Pancreas Transplantation, Department of Surgery, Seoul National University Hospital, Seoul, Korea;1. Institution of Medicine, Department of Respiratory Medicine and Allergology; Sahlgrenska University Hospital, Gothenburg, Sweden;2. Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden;3. Institution of Medicine, Department of Cardiology; Sahlgrenska University Hospital, Gothenburg, Sweden;4. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;5. Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden;1. Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium;2. Department of Obstetric, Cliniques Universitaires Saint-Luc, Brussels, Belgium;3. Department of Abdominal Surgery and Kidney Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium |
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| Abstract: | BackgroundNew-onset diabetes mellitus after transplantation (NODAT) is a leading cause of morbidity and mortality after heart transplantation (HT), which still remains a clinical challenge.MethodsIn this study, 522,708 follow-up records of HT were reviewed. After screening, 14,452 patients were analyzed when combined with immunosuppression records. We divided all patients into no-NODAT group, NODAT group, and preexisting diabetes group based on whether the patient had diabetes and the time when it occurred. Cox regression models were used to examine independent risk factors. A nomogram was established to predict the incidence of NODAT after HT. The machine learning method were used to confirm the prediction accuracy and reliability of the nomogram.ResultsPatients who experienced NODAT after HT had poor survival compared with those without NODAT. Tacrolimus, cyclosporine A (CsA), rapamycin, donor age, and recipient age at the time of transplant were significant predictors of NODAT. Tacrolimus had a more significant association with NODAT, followed by rapamycin and CsA. The nomogram method we adopted in this study had an accuracy of 63% in predicting the incidence of NODAT.ConclusionThe survival probability of HT recipients with NODAT showed a significant decreasing tendency. However, there was no difference in survival probability between patients with preexisting diabetes and patients with NODAT. Tacrolimus had a more significant association with NODAT than CsA and rapamycin. |
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