Diabetes doesn't rule out heart transplant success

If you have diabetes, your risk for heart failure is double that of someone without diabetes. The occurrence of heart failure has been rising in recent years as diabetes has become more common. In heart failure, the heart muscle is unable to pump blood as it should because it has lost strength. This is often a result of coronary artery disease or hypertension (high blood pressure). Coronary artery disease is a condition in which blood vessels supplying the heart muscle become clogged and unable to deliver enough blood to that muscle. The lack of blood, with its much-needed oxygen and nutrient supply, weakens the heart. And the heart, as it strains to deliver blood, pumps harder and harder.

Heart transplantation is thought to be the best treatment for severe heart failure, but some healthcare professionals believe that people with diabetes are not good candidates for the operation. This is partly because people with diabetes have an increased risk of complications, and partly because the drugs the person must take after the transplant can raise blood sugar (glucose). The drugs are taken so that the body doesn’t reject the new heart. They can, however, cause kidney damage.

These concerns are particularly important in light of the long lists of people waiting for hearts for transplant. In general, healthier individuals have had better long-term results.

But now there is evidence that the post-transplant survival rate among people with diabetes is similar to that of people who do not have diabetes—as long as the person with diabetes has no other complications. In a study published in  the November 21, 2006, issue of Circulation, a journal of the American Heart Association, researchers concluded that people with diabetes should not be disqualified from receiving a heart transplant because they have diabetes.

Similar actuarial survival rates
The investigators calculated actuarial survival (years) using time-to-event analysis among more than 20,000 people who received first-time heart transplantation, from 1995 through 2005. A total of 3,687 had diabetes at the time of transplantation. The results showed that the transplant recipients without diabetes could live longer than those with diabetes (median survival of 10.1 years vs. 9.0 years).

The researchers also compared the actuarial survival between heart transplantation recipients with uncomplicated diabetes and recipients who did not have diabetes. They found no significant difference between the two.

Complications paint a different picture
Diabetes complications do have a strong impact on a person’s survival after heart transplantation. The researchers looked at people who, in addition to having heart disease, suffered from diabetes-related complications such as kidney disease, a history of stroke, peripheral vascular disease, obesity, or a combination of these conditions. They found that long-term survival decreased with each additional complication.

Hope for everyone
In general, people who have diabetes face a higher risk of transplant complications, compared with people who do not have diabetes. But if individuals with diabetes do not have severe disease or a diabetes complication other than heart failure, these study findings show that their chance of a successful heart transplant is just about the same as for heart failure patients in general. If a person does have diabetes complications along with heart failure, treatment options other than transplantation may be available.