Sex Differences in Incidence and Outcomes of New-Onset Post-Transplant Diabetes Mellitus After Heart Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-04-15 DOI:10.1111/ctr.70143

Alice Chung, Heidi Hartman, Ersilia M. DeFilippis, Eleanor Keller, Stephanie Golob, Daniella Concha, Jaya Batra, Gabriel Sayer, Farhana Latif, Melana Yuzefpolskaya, Jayant Raikhelkar, Justin Fried, Koji Takeda, Nir Uriel, Kevin Clerkin

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引用次数: 0

Abstract

Introduction

Post-transplant diabetes mellitus (PTDM) is a common complication following heart transplantation (HT). The purpose of this study was to investigate sex differences in risk factors for the development of PTDM after HT, as well as in PTDM-related post-transplant outcomes, including acute cellular rejection (ACR), antibody-mediated rejection (AMR), cardiac allograft vasculopathy (CAV), and death.

Methods

A retrospective review of patients who underwent HT at a large-volume center between January 1, 2010 and December 31, 2019 was performed. PTDM was defined as hemoglobin A1C ≥ 6.5% or a random glucose >200 after HT among patients with no prior history of DM. Predictors of PTDM and post-HT outcomes were analyzed by sex.

Results

A total of 533 patients were transplanted during the study period and screened for inclusion. Among the 317 HT patients without pre-transplant DM, 71 (22.4%) developed PTDM: 24 women (33.7%), 47 men (66.2%). Baseline hypertension (OR 2.9, [1.3, 6.7], p = 0.009) and mean steroid dose over the first 2 years post-transplant (OR 1.2, [1.0, 1.3], p = 0.006) were predictors of PTDM in women but not in men, and mean tacrolimus dose was a predictor in men (OR 1.1, [1.0, 1.2], p = 0.001) but not in women while mean tacrolimus level was a predictor in women (OR 1.2, [1.0, 1.2], p = 0.034) but not in men. Post-transplant outcomes, including ACR, AMR, CAV, and death, did not differ between men with and without PTDM. However, women with PTDM had a higher rate of AMR (38% vs. 18%, p = 0.04) as compared to women without PTDM. There were no significant differences in rates of ACR, CAV, infection requiring hospitalization, or death among women.

Conclusion

PTDM is a common complication of HT. Our study suggests that risk factors for PTDM and outcomes among HT patients differ by sex.

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心脏移植后新发糖尿病的发病率和预后的性别差异

移植后糖尿病（PTDM）是心脏移植术后常见的并发症。本研究的目的是研究HT后PTDM发生的危险因素的性别差异，以及PTDM相关的移植后结局，包括急性细胞排斥反应（ACR）、抗体介导的排斥反应（AMR）、心脏异体移植血管病变（CAV）和死亡。方法回顾性分析2010年1月1日至2019年12月31日在大容量中心接受HT治疗的患者。PTDM的定义是：在没有糖尿病病史的患者中，治疗后糖化血红蛋白≥6.5%或随机血糖为200。PTDM和治疗后预后的预测因素按性别进行分析。结果在研究期间，共有533例患者接受了移植，并进行了纳入筛选。317例未发生移植前糖尿病的HT患者中，71例（22.4%）发生PTDM：女性24例（33.7%），男性47例（66.2%）。基线高血压（OR 2.9, [1.3, 6.7], p = 0.009）和移植后前2年的平均类固醇剂量（OR 1.2, [1.0, 1.3], p = 0.006）是女性PTDM的预测因子，而不是男性；他克莫司平均剂量是男性的预测因子（OR 1.1, [1.0, 1.2], p = 0.001），但不是女性；他克莫司平均水平是女性的预测因子（OR 1.2, [1.0, 1.2], p = 0.034），但不是男性。移植后的预后，包括ACR、AMR、CAV和死亡，在有和没有PTDM的男性之间没有差异。然而，与没有PTDM的女性相比，患有PTDM的女性有更高的AMR率（38%对18%，p = 0.04）。在ACR、CAV、需要住院治疗的感染或女性死亡率方面没有显著差异。结论PTDM是HT的常见并发症。我们的研究表明，ptsd的危险因素和HT患者的预后因性别而异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.