Effect of sodium glucose cotransporter 2 inhibition immediately prior to heart transplantation

Lisa M. Raven, MBBS, FRACP; Christopher A. Muir, MBBS (Hons), FRACP, PhD; Ricardo C. Deveza, MD, FRACP; Cassia Kessler Iglesias, MD (Hons), FRACP; Nicole K. Bart, MBBS (Hons), BSc (Med Sci), DPhil (Oxon), FRACP; Kavitha Muthiah, MBChB, PhD, FRACP; Eugene Kotlyar, MBBS, MD, MPVD, FRACP; 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

JHLT Open (Aug 2024)

Effect of sodium glucose cotransporter 2 inhibition immediately prior to heart transplantation

Lisa M. Raven, MBBS, FRACP,
Christopher A. Muir, MBBS (Hons), FRACP, PhD,
Ricardo C. Deveza, MD, FRACP,
Cassia Kessler Iglesias, MD (Hons), FRACP,
Nicole K. Bart, MBBS (Hons), BSc (Med Sci), DPhil (Oxon), FRACP,
Kavitha Muthiah, MBChB, PhD, FRACP,
Eugene Kotlyar, MBBS, MD, MPVD, FRACP,
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
Nicole K. Bart, MBBS (Hons), BSc (Med Sci), DPhil (Oxon), 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
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

Journal volume & issue: Vol. 5
p. 100088

Abstract

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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.

Published in JHLT Open

ISSN: 2950-1334 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery; Medicine: Internal medicine: Specialties of internal medicine
Website: https://www.sciencedirect.com/journal/jhlt-open

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