BACKGROUND Diabetes mellitus (DM) is a major cause of morbidity and mortality following heart transplantation (HT), with 21% and 35% of survivors being affected within 1 and 5 years following HT, respectively. Magnesium deficiency is common among HT patients treated with calcineurin inhibitors and is a known risk factor for DM in non-HT patients. We therefore investigated the association between serum Mg (s-Mg) levels and new-onset diabetes after transplantation (NODAT). METHODS Between 2002 and 2017, 102 non-DM HT patients were assessed. In accordance with the mean value of all s-Mg levels recorded during the first year post-HT, patients were divided into high s-Mg (≥ 1.8 mg/dL) and low s-Mg (< 1.8 mg/dL) groups. The endpoint was NODAT, defined according to the diagnostic criteria of the American Diabetes Association. RESULTS Baseline clinical and demographic characteristics for the high (n = 45) and low s-Mg (n = 57) groups were similar. Kaplan-Meier survival analysis showed that 15-year freedom from NODAT was significantly higher among patients with high vs low s-Mg (85% vs 46% log-rank test, p < 0.001). Consistently, multivariate analysis adjusted for age, gender, immunosuppression therapies, BMI and mean creatinine values in the first year post-HT, showed that low s-Mg was independently associated with a significant > 8-fold increased risk for NODAT (95% CI 2.15-32.63, p = 0.003). Stroke rate was significantly higher in patients with low s-Mg levels vs high s-Mg (14% vs 0, p = 0.025), as well as long term mortality (HR 2.6, 95% CI 1.02-6.77, p = 0.05). CONCLUSIONS Low s-Mg level post-HT is an independent risk factor for NODAT in HT patients. The implications of interventions, focusing on preventing or correcting low s-Mg, for the risk of NODAT and for clinical outcomes should be evaluated.

中文翻译：

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低镁血症与心脏移植后的新发糖尿病有关。

背景技术糖尿病（DM）是心脏移植（HT）后发病和死亡的主要原因，其中21％和35％的幸存者分别在HT发生后1年和5年内受到影响。镁缺乏在用钙调神经磷酸酶抑制剂治疗的HT患者中很常见，并且是非HT患者中DM的已知危险因素。因此，我们调查了血清Mg（s-Mg）水平与移植后新发糖尿病（NODAT）之间的关系。方法在2002年至2017年期间，对102名非糖尿病HT患者进行了评估。根据HT后第一年记录的所有s-Mg水平的平均值，将患者分为高s-Mg（≥1.8 mg / dL）和低s-Mg（<1.8 mg / dL）组。终点为NODAT，根据美国糖尿病协会的诊断标准定义。结果高（n = 45）和低s-Mg（n = 57）组的基线临床和人口统计学特征相似。Kaplan-Meier生存分析表明，高s-Mg和低s-Mg患者的NODAT 15年自由度显着更高（对数秩检验分别为85％和46％，p <0.001）。一致地，对HT后第一年的年龄，性别，免疫抑制疗法，BMI和平均肌酐值进行多因素分析，结果表明，低s-Mg与NODAT风险显着增加> 8倍相关（95％CI 2.15-32.63，p ＝ 0.003）。低s-Mg水平与高s-Mg（14％vs 0，p = 0.025）和长期死亡率的患者中风发生率显着更高（HR 2.6，95％CI 1.02-6.77，p = 0.05） 。结论HT后低s-Mg水平是HT患者NODAT的独立危险因素。