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Diabetes und Herztransplantation

Diabetes and heart transplantation

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Summary

Diabetes is frequently encountered in patients presenting with end-stage heart failure to be listed for transplantation. While diabetes used to be a contra-indication for heart transplantation, careful preoperative evaluation and individualized postoperative medication lead to long-term outcome after heart transplantation equal to non-diabetic patients. About 1/3 of transplanted patients develop a post-transplant diabetes. Several risk factors have been identified leading to this condition. Mostly, post-transplant diabetes is of temporary nature. Several studies have shown no impact of diabetes on the incidence of rejection, malignancies, and transplant vasculopathy. However, glucose intolerance must be taken into consideration when planing immunosuppressive therapy since different medications have distinct impact on glucose metabolism after transplant. A multidisciplinary team allows for closely monitoring and treating patients with diabetes after heart transplant.

Zusammenfassung

Patienten, die zur Herztransplantation vorgestellt werden, haben häufig einen Diabetes mellitus. In der Vergangenheit galt Diabetes als eine relative Kontraindikation zur Transplantation. Heute können mit einer gewissenhaften Patientenauswahl und engmaschigen postoperativen Nachbetreuung Langzeitergebnisse der Herztransplantation bei Diabetikern erreicht werden, die sich nicht von denen bei Nichtdiabetikern unterscheiden. Ca. 30% der Empfänger entwickeln einen Posttransplantations-Diabetes, der meist von vorübergehender Natur ist. Mehrere Studien haben zeigen können, dass eine diabetische Stoffwechsellage keinen Einfluss auf die Häufigkeit von Abstosßungen, Malignomen und Transplantatvaskulopathie hat. Allerdings muss berücksichtigt werden, dass die verschiedenen Immunsuppressiva unterschiedliche Wechselwirkungen mit der diabetischen Stoffwechsellage haben. Mit Hilfe eines multidisziplinären Teams gelingt es, Diabetiker auch nach Herztransplantation effektiv zu behandeln.

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  1. Direktor Lungentransplantation, Department of Surgery, Baylor College of Medicine, 6560 Fannin Suite 1860, Houston TX 77030, USA

    M. Loebe

  2. Multi-Organ-Transplant Center, The Methodist Hospital and Baylor College of Medicine, Houston TX, USA

    K. Ramasubbu &  D. J. Hamilton

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Loebe, M., Ramasubbu, K. & Hamilton, D.J. Diabetes und Herztransplantation. Clin Res Cardiol 95 (Suppl 1), i48–i53 (2006). https://doi.org/10.1007/s00392-006-1121-0

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