The Effects of Diabetes on the Heart Transplantation Procedure
Heart transplants are complex procedures requiring multiple circumstances to align in order to proceed. A heart must be of valid tissue, the donor must be able to be accepted by the recipient, and other medical circumstances permit the procedure be performed. However, one specific chronic condition has recently been brought to light in its effects on the procedure and life expectancy post-op. That condition is known as Diabetes Mellitus. DM is a condition where the body’s blood glucose becomes out of normal ranges due to Insulin intolerance or lack of production. These patients tend to suffer from issues involving organ damage or failure to the eyes, kidneys, nerves, blood vessels, and heart. It can even lead in extreme cases to ketoacidosis or nonketotic hyperosmolar syndrome. Further complications involving the vascular system include atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease. This complex disease provides all the above obstacles as well as hypertension and abnormal lipoprotein metabolism. However, the light I mentioned above displays how exactly this affects the ability of patients to receive and survive heart transplant surgeries. (Diabetes, 2004) Some medical professionals reported a study to the American Journal Of Critical Care on their findings. They compared 347 recipients, 64 of which were diabetic patients taking insulin where the remaining 283 were not.
All patients had a mean age within their 50’s providing a consistent frame of study. Each outcome was documented and recorded for length of survival, days of hospitalization, acute graft rejection, infection, cardiac allograft vasculopathy, stroke, cancer, and renal dysfunction. They found a significant trend in the time in hospital within the diabetic population, showing more return visits due to infections and other complications cardiovascular, gastrointestinal, respiratory, renal, hematologic, and neurological systems. However, there was no significant difference found in length of survival, rates of rejection, infection, cardiac allograft vasculopathy, stroke, cancer, or renal dysfunction. This displays that while being subjected to pretransplant DM may result in more hospital time over the first three years, patients suffering from this disorder will likely still fare just as well with life expectancy and experience minimal additional complications to those without the chronic illness. This new information proves clinically valuable and irrefutably crucial to the discussion of whether these patients deserve a lower sense of urgency when on the transplant list. (Jalowiec, A et al, 2017)
In conclusion, diabetes mellitus proves itself to still be a clinically troublesome impairment for most patients, but it does not have a strong baring on the probability of a patient to successfully receive an open heart transplant procedure. This new information will help further understand the risks associated with not only each of these clinical manifestations, diabetes mellitus and open heart transplant surgery, in combination but also as individual complications. Understanding how the two of these interact and understanding that while they may have similar application to certain bodily systems their negative effects are not synergistic allows for further clinical advancements in both directions. Further research should examine more patients both with and without diabetes mellitus receiving heart transplant surgery, but also evaluate if there is a significant change in outcome based on whether they have type 1 or type 2 of the disorder. Exploring more clinical results with patients from both of those demographics along side even more patients without these conditions will bring an even more accurate understanding to the difference between both types effect on heart transplant surgery and whether these results were due to the limited sample size beneath 500 participants.
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