The Clinical Course and Outcomes of Post-Transplantation Diabetes Mellitus after Heart Transplantation

The aim of this study was to describe in more detail the predisposition, natural course, and clinical impact of post-transplantation diabetes mellitus (PTDM) after heart transplantation (HT). The characteristics and clinical outcomes of 54 patients with PTDM were compared with those of 140 patients without PTDM. The mean age of PTDM patients was significantly higher than controls (48.9 ± 9.3 vs 38.6 ± 13.3 yr, respectively, P = 0.001), and ischemic heart disease was a more common indication of HT (20.4% [11/54] vs 7.1% [10/140], respectively, P = 0.008). In multivariate analysis, only recipient age (odds ratio, 1.80; 95% confidence interval, 1.35-2.40; P = 0.001) was associated with PTDM development. In 18 patients (33%), PTDM was reversed during the follow-up period, and the reversal of PTDM was critically dependent on the time taken to develop PTDM (1.9 ± 1.0 months in the reversed group vs 14.5 ± 25.3 months in the maintained group, P = 0.005). The 5-yr incidence of late infection (after 6 months) was higher in the PTDM group than in the control group (30.4% ± 7.1% vs 15.4% ± 3.3%, respectively, P = 0.031). However, the 5-yr overall survival rate was not different (92.9% ± 4.1% vs 85.8% ± 3.2%, respectively, P = 0.220). In conclusion, PTDM after HT is reversible in one-third of patients and is not a critical factor in patient survival after HT.     

Mortality risk in post‐transplantation diabetes mellitus based on glucose and HbA1c diagnostic criteria

Current diagnostic criteria for post‐transplantation diabetes mellitus (PTDM) are either fasting plasma glucose ≥7.0 mmol/l (≥126 mg/dl) or postchallenge plasma glucose ≥11.1 mmol/l (≥200 mg/dl) 2 h after glucose administration [oral glucose tolerance test (OGTT) criterion]. In this retrospective cohort study of 1632 renal transplant recipients (RTRs) without known diabetes mellitus at the time of transplantation, we estimated mortality hazard ratios for patients diagnosed with PTDM by either conventional glucose criteria or the proposed glycated haemoglobin (HbA1c) criterion [HbA1c ≥6.5% (≥48 mmol/mol)]. During a median follow‐up of 7.0 years, 311 patients died. Compared with nondiabetic patients and after adjustment for confounders, patients diagnosed with PTDM based on chronic hyperglycaemia early after transplantation (manifest PTDM) or by the OGTT criterion at 10 weeks post‐transplant suffered a higher mortality risk (HR 1.59, 95% CI 1.06–2.38, P = 0.02 and HR 1.56, 95% CI 1.04–2.38, P = 0.03, respectively). In contrast, patients diagnosed with PTDM by the HbA1c criterion at 10 weeks or between 10 weeks and 1 year post‐transplant were not associated with mortality (HR 0.96, 95% CI 0.61–1.51, P = 0.86 and 1.58, 95% CI 0.74–3.36, P = 0.24 respectively). After adjustment for confounders and competing risks, only patients with manifest PTDM had a significantly higher cardiovascular mortality risk (subdistributional HR 2.31, 95% CI 1.19–4.47, P < 0.001). Since many cases with PTDM were only identified by the OGTT, we recommend monitoring fasting plasma glucose early after renal transplantation followed by an OGTT at 2–3 months post‐transplant in patients without overt diabetes mellitus.     

Leptin – A new marker for development of post-transplant diabetes mellitus?

Introduction

Obese patients have increased leptin production and selective resistance to its central anti-adipogenic effects, yet its pro-inflammatory immunostimulating effects persist.

肝移植术后糖尿病的最新进展

糖尿病是肝移植术后最常见的并发症之一,肝移植术后并发糖尿病的受者生存率及移植物长期存活率明显低于无糖尿病的肝移植受者。近年来,随着肝移植在中国迅速发展,肝移植术后糖尿病也引发了高度关注。尽管过去20余年对于移植后糖尿病(PTDM)的研究从未停歇,但仍有许多问题有待进一步研究解决。本文旨在总结肝移植术后糖尿病的最新研究进展,包括PTDM的定义与诊断标准,肝移植术后糖尿病的危险因素、预防及治疗等,以期加深对于肝移植术后糖尿病的认识和理解,并进行有效预防和治疗,从而提高肝移植受者长期存活率及生活质量。     

他克莫司引起继发性糖尿病的临床转归和药学监护

目的:对2例他克莫司(FK506)引起的继发性糖尿病(PTDM)患者进行随访并总结此类患者药学监护要点。方法:检索近年来国内外PTDM相关文献,指导患者正确使用降糖药物,进行规律血糖监测并复查糖代谢相关指标。结果:PTDM的发生机制类似于2型糖尿病,但其具有显著特点:发生PTDM多于移植后30～60d;随着移植时间的延长,胰岛素用量会较前显著减少,甚至停用;降糖策略应以胰岛素治疗为主。2例患者血糖水平较PTDM诊断初期均明显改善,降糖药物剂量明显减少。第1例患者在治疗过程中未发生严重低血糖,并在1年后PTDM临床缓解,血清C肽检查示胰岛细胞功能恢复良好;第2例患者发生PTDM后饮食控制不严格,血糖控制不达标,目前仍使用胰岛素控制血糖。结论:应重视他克莫司引起的PTDM,正确认识PTDM并指导患者规律监测血糖和合理使用降糖药物,防止发生低血糖。     

肝移植术后糖尿病的初步研究

目的 探讨肝移植术后糖尿病的发生规律和对病人的影响。方法 收集2000年7月～2003年1月间35例长期存活的肝移植病人的临床资料,观察移植术后糖尿病(Post Transplantation Diabcte Mellitus,PTDM)与病人年龄、免疫抑制剂、皮质激素用量和原发病之间的关系及PTDM对病人的影响。结果 术后新出现11例糖尿病,术前空腹血糖和年龄对PT-DM的发生无明显影响。FK506(普乐可复)组和CSA(环孢霉素)组的PTDM发生率无明显差别。晚期肝硬化和接受大剂量皮质激素冲击治疗的病人术后PTDM的发生率明显升高。PTDM对病人术后巨细胞病毒(CMV)感染率无明显影响。结论肝移植术后糖尿病的发生与晚期肝硬化和大剂量激素冲击治疗相关,与年龄和术前空腹血糖无关。