Christopher S. Hayward, BMedSc, MBBS (Hons), MD, FRACP,
Peter S. Macdonald, MBBS, MD, PhD, FRACP,
Andrew Jabbour, BSc (Med), MBBS (Hons), PhD, FRACP,
Jerry R. Greenfield, MBBS (Hons 1), PhD, FRACP
Affiliations
Lisa M. Raven, MBBS, FRACP
Department of Diabetes and Endocrinology, St Vincent’s Hospital, Sydney, NSW, Australia; Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, NSW, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Corresponding author: Lisa M. Raven, MBBS, FRACP, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, NSW 2010, Australia.
Christopher A. Muir, MBBS (Hons), FRACP, PhD
Department of Diabetes and Endocrinology, St Vincent’s Hospital, Sydney, NSW, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
Ricardo C. Deveza, MD, FRACP
School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Heart and Lung Transplantation, St Vincent’s Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
Cassia Kessler Iglesias, MD (Hons), FRACP
School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Heart and Lung Transplantation, St Vincent’s Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Heart and Lung Transplantation, St Vincent’s Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
Kavitha Muthiah, MBChB, PhD, FRACP
School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Heart and Lung Transplantation, St Vincent’s Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
Eugene Kotlyar, MBBS, MD, MPVD, FRACP
School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Heart and Lung Transplantation, St Vincent’s Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
Christopher S. Hayward, BMedSc, MBBS (Hons), MD, FRACP
School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Heart and Lung Transplantation, St Vincent’s Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
Peter S. Macdonald, MBBS, MD, PhD, FRACP
School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Heart and Lung Transplantation, St Vincent’s Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
Andrew Jabbour, BSc (Med), MBBS (Hons), PhD, FRACP
School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Heart and Lung Transplantation, St Vincent’s Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
Jerry R. Greenfield, MBBS (Hons 1), PhD, FRACP
Department of Diabetes and Endocrinology, St Vincent’s Hospital, Sydney, NSW, Australia; Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, NSW, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
Sodium glucose cotransporter 2 inhibitors (SGLT2i) are an established treatment for heart failure and type 2 diabetes. Guidelines suggest withholding SGLT2i preoperatively due to the risk of ketoacidosis. Orthotopic heart transplantation (OHT) occurs without sufficient notice to cease SGLT2i treatment before surgery. In a retrospective analysis of 163 OHT recipients (40 exposed to SGLT2i, 123 not exposed), we show no increase in rates of mild, moderate, or severe acidosis postoperatively. No cases of ketoacidosis occurred, likely due to the fact that 97% of patients received insulin infusions postoperatively for transient postoperative hyperglycemia. Patients exposed to SGLT2i had shorter length of stay in the intensive care unit and improved adjusted survival overall. These findings support the safety of SGLT2i use up to the time of OHT with routine use of a postoperative insulin infusion.
