Post-transplant diabetes mellitus following heart transplantation

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

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.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Diabetes Mellitus* / epidemiology
  • Diabetes Mellitus* / etiology
  • Heart Transplantation* / adverse effects
  • Humans
  • Hyperglycemia* / chemically induced
  • Hyperglycemia* / complications
  • Hyperglycemia* / drug therapy
  • Immunosuppressive Agents / adverse effects
  • Risk Factors

Substances

  • Immunosuppressive Agents