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Impact of Diabetes Mellitus on Survival in Patients Bridged to Transplantation with Left Ventricular Assist Devices in the United States

Al-Kindi, Sadeer G.*; Al-Suwaidi, Jassim; Jayyousi, Amin; Oliveira, Guilherme H.*; Abi Khalil, Charbel†,§

doi: 10.1097/MAT.0000000000000896
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Diabetes mellitus (DM) is associated with increased mortality in advanced heart failure and in patients undergoing cardiac surgery. However, its impact on outcomes in patients supported with left ventricular assist devices (LVAD) is not well established. We queried the United Network for Organ Sharing (UNOS) for all adults listed for heart transplantation and bridged with continuous-flow LVAD in the United States from 2000 to 2015. We compared the pre- and post-transplant mortality of patients with and without DM. Unadjusted and adjusted time-event analyses were performed. A total of 4,978 patients were included in this analysis, of whom 33% had DM. Mean age was 53 ± 12 years, 79% were male, and 65% were Caucasian. Compared with those without, patients with DM were older (age 52 vs. 57 years; p < 0.001), more likely to be male (78% vs. 82%; p = 0.007), smokers (52% vs. 57%; p = 0.011), obese (mean body mass index [BMI] 28 vs. 30; p < 0.00), and have ischemic cardiomyopathy (37% vs. 53%; p < 0.001). Diabetes mellitus was not associated with increased wait-list mortality (adjusted hazard ratio [HR]: 1.16 [0.88–1.53]; p = 0.30), or wait-list mortality/delisting (HR: 1.17 [0.97–1.41]; p = 0.11). Among patients who underwent transplantation, DM was associated with increased adjusted overall mortality (HR: 1.23 [1.002–1.52]; p = 0.048). One-third of patients bridged-to-transplantation with LVAD in the United States have DM. While it does not increase wait-list mortality or delisting, DM is associated with decreased post-transplantation survival.

From the *Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio

Department of Adult Cardiology, Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar

Department of Diabetes, Hamad Medical Corporation, Doha, Qatar

§Department of Medicine and Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.

Submitted for consideration March 2018; accepted for publication in revised form August 2018.

Disclosure: The authors have no conflicts of interest to report.

This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. None of the authors have conflicts of interest to report. Dr. Charbel Abi Khalil is funded by the Qatar National Research Funds (QNRF) under its National Priority Research Programs (NPRP), Grant 9-169-3-024. All of the above-mentioned sources did not have a role in the study’s concept, analysis, and writing of the manuscript.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Charbel Abi Khalil, Department of Medicine and Genetic Medicine, Weill Cornell Medicine-Qatar, PO Box 24144, Doha, Qatar. Email: cha2022@med.cornell.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs