[Impact of diabetes mellitus on heart transplant recipients]. / Impacto de la diabetes mellitus en el paciente con trasplante cardiaco.

INTRODUCTION AND OBJECTIVES: At present, there is some controversy about the impact of diabetes mellitus on heart transplant patients. The effect of the disease on mortality and on other complications, such as infection or rejection, is unclear. The objective of this study was to investigate these factors in our heart transplant patients. METHODS: We studied 365 consecutive patients who underwent heart transplantation between November 1987 and May 2003. We divided them in three groups according to whether they had pretransplantation diabetes (group 1), de novo diabetes (group 2), or no diabetes (group 3). Baseline variables and the development of complications were recorded, and findings were analyzed using Student's t test, chi squared test, and Kaplan-Meier survival analysis. RESULTS: There was no difference in the 1-year or 5-year survival rate between the groups (P=.24 and P=.32, respectively). Patients with pretransplantation and de novo diabetes were older (54.6 years vs 54.9 years vs 50.6 years, P=.04), had a higher prevalence of hypertension (48% vs 36% vs 23%, P=.001), and had more frequently been treated with tacrolimus (10% vs 12% vs 4%, P=.04) or steroids (92% vs 86% vs 70%, P=.001). The incidence of rejection during follow-up was greater in these two groups (64% vs 70% vs 45%, P=.001). CONCLUSIONS: Neither pretransplantation diabetes nor de novo diabetes had a negative impact on survival in our heart transplant patients. The disease's presence was associated with treatment with steroids and tacrolimus. In these patients it would be preferable to individualize immunosuppressive therapy.

Impacto de la diabetes mellitus en el paciente con trasplante cardiaco / Impact of diabetes mellitus on heart transplant recipients

Introducción y objetivos. Actualmente, el impacto de la diabetes mellitus en los pacientes con trasplante cardiaco es controvertido y su efecto sobre la mortalidad y otras complicaciones, como las infecciones y los rechazos, no está completamente aclarado. El objetivo de este estudio es analizar estos efectos en nuestra población de pacientes trasplantados. Métodos. Se ha estudiado a una población de 365 pacientes consecutivos con trasplante cardiaco desde noviembre de 1987 hasta mayo de 2003, dividiéndolos en 3 grupos en función de la presencia de diabetes pretrasplante (grupo 1), diabetes de novo (grupo 2) y no diabéticos (grupo 3). Se analizaron variables tanto basales como de complicaciones evolutivas, y los resultados se compararon mediante test t de Student, test χ² y método de Kaplan-Meier para la supervivencia. Resultados. No apreciamos diferencias entre grupos en la supervivencia al año (p = 0,24) ni a 5 años (p = 0,32). Los pacientes de los grupos con diabetes mellitus pretrasplante y de novo tenían mayor edad (54,6 frente a 54,9 frente a 50,6 años; p = 0,04), mayor prevalencia de hipertensión arterial (el 48, el 36 y el 23%; p = 0,001) y mayor porcentaje de tratamiento con tacrolimus (el 10, el 12 y el 4%; p = 0,04) y esteroides (el 92, el 86 y el 70%; p = 0,001). Evolutivamente, estos 2 grupos presentan mayor incidencia de rechazo (el 64, el 70 y el 45%; p = 0,001). Conclusiones. La diabetes previa al trasplante o de novo no tuvo impacto negativo sobre la supervivencia de nuestros pacientes trasplantados. Su presencia se asocia al tratamiento con esteroides y tacrolimus. En estos pacientes sería deseable realizar un ajuste individualizado de la inmunodepresión

Introduction and objectives. At present, there is some controversy about the impact of diabetes mellitus on heart transplant patients. The effect of the disease on mortality and on other complications, such as infection or rejection, is unclear. The objective of this study was to investigate these factors in our heart transplant patients. Methods. We studied 365 consecutive patients who underwent heart transplantation between November 1987 and May 2003. We divided them in three groups according to whether they had pretransplantation diabetes (group 1), de novo diabetes (group 2), or no diabetes (group 3). Baseline variables and the development of complications were recorded, and findings were analyzed using Student's t test, chi squared test, and Kaplan-Meier survival analysis. Results. There was no difference in the 1-year or 5-year survival rate between the groups (P=.24 and P=.32, respectively). Patients with pretransplantation and de novo diabetes were older (54.6 years vs 54.9 years vs 50.6 years, P=.04), had a higher prevalence of hypertension (48% vs 36% vs 23%, P=.001), and had more frequently been treated with tacrolimus (10% vs 12% vs 4%, P=.04) or steroids (92% vs 86% vs 70%, P=.001). The incidence of rejection during follow-up was greater in these two groups (64% vs 70% vs 45%, P=.001). Conclusions. Neither pretransplantation diabetes nor de novo diabetes had a negative impact on survival in our heart transplant patients. The disease's presence was associated with treatment with steroids and tacrolimus. In these patients it would be preferable to individualize immunosuppressive therapy

Fisica experimental para ingenieria: mecanica

Contenido: Procedimiento general, analisis teorico del problema, redaccion de informes, procedimientos, medicion, registro y tratamiento de resultados, calculo de errores, experimento modelo.