Impact of diabetic kidney disease on clinical outcomes following heart transplantation
T Chaemchoi, A Intrarakamhang, K Thammanatsakul, S Sinphurmsukskul, S Siwamogsatham, S Puwanant, A Ariyachaipanich, T SnabboonAbstract
Background
Evidence regarding the prevalence and clinical outcomes of diabetic kidney disease (DKD) following heart transplantation (HTx) remains limited.
Purpose
To determine the prevalence of DKD and evaluate its impact on clinical outcomes after HTx.
Methods
A retrospective cohort study was conducted on consecutive adult patients who underwent first-time HTx at a single center between 2012 and 2023 and survived to hospital discharge. These patients were prospectively followed until December 31, 2024. Pre-HTx DKD was defined as diabetes with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g creatinine), prior to transplantation. Post-HTx DKD was defined as the coexistence of new-onset diabetes mellitus and albuminuria in patients without pre-existing diabetes, assessed from three months after HTx onward. Patient survival was assessed using the Kaplan-Meier method, with group comparisons performed using the log-rank test. Multivariate risk factors were analyzed using Cox proportional hazards models.
Results
During a median follow-up of 58 months (Interquartile range 26-94), 103 HTx patients were included; 80% were male, with a mean age of 45.2 ± 12.3 years. Pre-HTx type 2 diabetes mellitus (T2DM) was observed in 18 patients (17.5%), and an additional 18 patients (17.5%) developed post-HTx T2DM. Among those with pre-HTx T2DM, 6 patients (5.8%) were diagnosed with pre-HTx DKD; one of whom also had diabetic retinopathy and diabetic foot complications. Of those diagnosed with post-HTx T2DM, two patients (1.9%) developed post-HTx DKD. Overall, 6 patients (5.8%) required chronic dialysis after HTx. Pre-HTx DKD (HR, 10.08; 95% CI, 1.61- 62.91; p = 0.013) and sustained decline in kidney function within one year post-HTx (HR, 15.15; 95% CI, 2.47– 92.84; p = 0.003) were independent predictors of post-HTx dialysis. Fifteen deaths occurred during follow-up, with causes including sepsis (n = 3), intracerebral hemorrhage (n = 3), graft failure (n = 2), sudden cardiac arrest (n = 2), cardiogenic shock (n = 1), malignancy (n = 1), and unknown causes (n = 3). Mortality rates did not differ significantly among patients with pre-HTx T2DM, post-HTx T2DM, and those without diabetes (p = 0.166). However, Multivariate analysis indicated that post-HTx DN (HR, 10.66; 95% CI, 1.29-88.33; p = 0.028) and post-HTx dialysis (HR, 9.13; 95% CI, 2.95-28.29, p < 0.001) were independently associated with increased mortality after HTx.
Conclusions
Although DKD is an uncommon complication of T2DM in heart transplant recipients, its presence is associated with a substantially increased risk of post-transplant dialysis and mortality. These findings highlight the importance of early identification and close renal monitoring in patients at risk for DKD following heart transplantation.Kaplan-Meier analysis dialysis outcomeFor image description, please refer to the figure legend and surrounding text.Survival analysis between post-HTx DKDFor image description, please refer to the figure legend and surrounding text.