BACKGROUND Endocrine disorders in patients after heart transplantation (HT) remain understudied. We aimed to assess endocrine profiles and management of HT recipients in the early post- transplant period. METHODS We conducted a retrospective cohort study on 123 consecutive HT recipients in the Advanced Heart Failure and Transplantation Programme between 2009 and 2018. All recipients had per-protocol endocrine follow-up within the first postoperative year. The median time to first post-transplant endocrine follow-up was 3 months (IQR 2-4). We assessed the incidence of vitamin D deficiency, bone mineral density, history of low energy fractures, hypogonadism in male recipients, posttransplant diabetes mellitus, and thyroid and parathyroid function. RESULTS We enrolled 22 women and 101 men of median age 57 years (IQR 50-63). Post-transplant diabetes mellitus developed in 14 patients (11.4%). 18 of 25 patients (14.6%) with preexisting type 2 diabetes mellitus required intensification of antidiabetic therapy. 38 male patients (40.4%) had hypogonadism. 5 patients (4.6%) were hypothyroid and 10 (9.3%) latent hyperthyroid. Secondary hyperparathyroidism was present in 19 (17.3%), 25-hydroxyvitamin D deficiency in 64 (54.7%) of patients. Osteoporosis was present in 26 (21.1%), osteopenia in 59 (48.0%) patients. 47 vertebral fractures, 3 hip and 1 humerus fractures occurred in 21 patients. Most of the patients had coincidence of two or three disorders, while less than 5% did not have any endocrine irregularities. All patients received calcium and vitamin D supplements. Forty-six patients (37.4%) were treated with zoledronic acid, 12 (9.8%) with oral bisphosphonates. Two patients were treated with teriparatide. CONCLUSIONS The prevalence of multiple endocrine disorders early after heart transplantation is high. Assessment and management of increased fracture risk and all other potentially affected endocrine axes should be considered as a standard of care in this early period.

中文翻译：

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心脏移植后的内分泌失调：国家队列研究。

背景技术心脏移植（HT）后患者的内分泌失调仍未得到充分研究。我们旨在评估移植后早期的内分泌概况和HT受体的治疗。方法我们对2009年至2018年间在“高级心力衰竭和移植计划”中的123位连续HT接受者进行了一项回顾性队列研究。所有接受者在术后第一年均接受了按方案的内分泌随访。首次移植后内分泌随访的中位时间为3个月（IQR 2-4）。我们评估了维生素D缺乏症的发生率，骨矿物质密度，低能骨折史，男性接受性腺功能低下，移植后糖尿病以及甲状腺和甲状旁腺功能。结果我们纳入了22位女性和101位男性，中位年龄为57岁（IQR 50-63）。移植后糖尿病患者14例（11.4％）。25名先前存在2型糖尿病的患者中有18名（14.6％）需要加强抗糖尿病治疗。男性性腺功能减退38例（40.4％）。甲状腺功能减退的患者5例（4.6％），潜在甲状腺功能亢进的患者10例（9.3％）。继发性甲状旁腺功能亢进症的患者为19（17.3％），其中25-羟基维生素D缺乏症的患者为64（54.7％）。骨质疏松症存在26（21.1％），骨质疏松症存在59（48.0％）。21例患者发生47例椎体骨折，3例髋关节和1例肱骨骨折。大多数患者有两种或三种疾病的巧合，而少于5％的患者没有任何内分泌异常。所有患者均接受钙和维生素D补充剂。唑来膦酸治疗46例患者（37.4％），口服双膦酸盐治疗12例（9.8％）。两名患者接受特立帕肽治疗。结论心脏移植术后多种内分泌疾病的患病率很高。在这一早期阶段，应考虑增加骨折风险和所有其他可能受影响的内分泌轴的评估和管理，作为护理的标准。