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Review
. 2022 Nov;41(11):1537-1546.
doi: 10.1016/j.healun.2022.07.011. Epub 2022 Jul 19.

Post-transplant diabetes mellitus following heart transplantation

Joshua D Newman  1 , Kelly H Schlendorf  1 , Zachary L Cox  2 , Sandip K Zalawadiya  1 , Alvin C Powers  3 , Kevin D Niswender  3 , Ravi V Shah  1 , JoAnn Lindenfeld  4
Affiliations
Review

Post-transplant diabetes mellitus following heart transplantation

Joshua D Newman et al. J Heart Lung Transplant. 2022 Nov.

Abstract

Post-transplant diabetes mellitus (PTDM) is common following heart transplant, impacting greater than 20% of patients with most cases occurring in the first year after transplant. PTDM is associated with multiple negative sequelae including increased post-operative infections, a higher rate of renal failure, and increased mortality. Compared with pre-transplant diabetes mellitus, PTDM has several unique risk factors and immunosuppressive medications play an important role in disease pathophysiology. Newer treatments for hyperglycemia, including glucagon like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors, may counter the mechanisms of immunosuppression-related hyperglycemia making them an appealing treatment option for patients with PTDM. Here, we review the definitions, incidence, risk factors, pathophysiology, clinical outcomes, treatment options, pharmacologic considerations, and future directions in PTDM.

Keywords: GLP-1 receptor agonists; SGLT-2 inhibitors; heart transplantation; immunosuppression; post-transplant diabetes mellitus.

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Conflict of interest statement

Disclosure statement J.L. receives research funding form AstraZeneca and Volumetrix and consults for Abbott, Abiomed, AstraZeneca, Alleviant, Bayer, Boston Scientific, Boehringer Ingelhiem, CVRx, Edwards Lifesciences, Merck, and VWave. R.S. receives research funding from the National Institutes of Health and the American Heart Association and consults for Myokardia, Cytokinetics, and Best Doctors. He serves on a scientific advisory board for Amgen. The remaining authors have no relevant disclosures to report. The authors wish to thank Ms. Teresa Ruggle for her assistance in preparing the figures for the manuscript. This work was facilitated by the Vanderbilt Diabetes Research and Training Center (DK20593).

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