Introduction: Diabetes mellitus (DM) is associated with poor survival after heart transplant (HT). However, the significance of glycemic control in diabetic HT recipients have not been studied yet. Our aim is to establish if poor glycemic control evaluated by glycated hemoglobin (HbA1c) is related with a poor prognosis.
Material & methods: We analyzed prospectively all HT recipients in our center from 2002. Attending on DM diagnostic criteria from American Diabetes Association, our sample is divided in non-DM patients, those with pre-existing DM before HT and those who developed DM after HT. In-hospital mortality cases were excluded. We evaluated survival free of cardiovascular (CV) death and cardiac allograph vasculopathy (CAV) in these groups. Finally, we assessed influence of glycemic control using average HbA1c in their follow-up after HT.
Results: 209 patients were included in the analysis (figure 1). 

Univariate analyses reveals an increase of combined endpoint (CV death and CAV) in DM patients (pre-existing and new onset) with an OR of 2,5 (p=0,08; IC 95% 1,29 – 5,02). Howeve, it did not shows poor prognosis for each 1% increase in HbA1c en DM patients (OR 0,92; IC 95% 0,61-1,38) or subgroups attending on HbA1c. Survival analysis in diabetic and non-diabetic patients is represented in the figures 2 and 3.

Survival analysis in diabetic patients depending on mean HbA1c is described in the figure 4.

Discussion: DM is associated with poor prognosis after HT as happen in another series. This poor prognosis probably include both pre-existing and new onset DM but our sample is small to find statistically significant differences. However, specifically in DM patients, mean HbA1c is not related with a worse outcome. It may means that HbA1c is not a good marker for HT patients or we don’t know nowadays optimal target HbA1 for HbA1c recipients.
Conclusions: DM is related with poor prognosis in HT recipients, but to accomplish a good glycemic control based on HbA1c does not decrease its adverse events.