Carbohydrate Metabolism Disorders in Relation to Cardiac Allograft Vasculopathy (CAV) Intensification in Heart Transplant Patients According to the Grading Scheme Developed by the International Society for Heart and Lung Transplantation (ISHLT)

Abstract

BACKGROUND Cardiac allograft vasculopathy (CAV) is the leading complication limiting the long-term survival of heart transplant (HTx) patients. The goal of this study was to assess carbohydrate metabolism disorders in relation to CAV intensification in heart transplant patients according to the ISHLT grading scheme. MATERIAL AND METHODS This retrospective study involved 477 HTx recipients undergoing angiographic observation for up to 20 years after transplantation. The patients were assigned to 4 groups on the basis of their carbohydrate metabolism status: without diabetes, with type 2 diabetes prior to HTx, with new-onset diabetes after transplantation, and with transient hyperglycemia. RESULTS In the study, 62.7% (n=299) of the patients manifested no diabetes after HTx, while 14.3% (n=68) of patients had type II diabetes prior to HTx and 18.4% (n=88) developed new-onset diabetes after transplantation. In total, 1442 coronary angiograms were taken in the specified control periods. CAV incidence increased over time after transplantation, reaching 11% after 1 year, 57% after 10 years, and 50% after 20 years. The longest survival time was observed for patients who had developed type II diabetes prior to HTx, but the difference was not statistically significant. The multivariate analysis failed to identify an independent risk factor for developing cardiac allograft vasculopathy. CONCLUSIONS Despite the relatively high rates of CAV and carbohydrate metabolism disorders in heart transplant patients, our retrospective analysis revealed no statistically significant link between these 2 diseases.

Figure 1

Selection of the studied population and the total number of angiograms taken 1, 2, 4, 7, 10, 15, and 20 years after heart transplantation (STATISTICA 13.3 by StatSoft).

Figure 2

Incidence of CAV over time (STATISTICA 13.3 by StatSoft).

Figure 3

Kaplan-Meier survival analysis with division into 3 groups (STATISTICA 13.3 by StatSoft).

Figure 4

Chart presenting the results of the analysis of risk factors for developing CAV, using Cox proportional-hazards models. A univariate analysis was performed for all the risk factors. The multivariate model only contains variables with a sufficient number of observations. For risk factors with both types of regression, univariate and uncorrected HR values are presented above, whereas corrected HR values with multiple variables can be found below (STATISTICA 13.3 by StatSoft).