Energy metabolism in diabetic and nondiabetic heart transplant recipients

Stefano Benedini, Roberto Fiocchi, Alberto Battezzati, Paola Scifo, Lucia Piceni Sereni, Amando Gamba, Carmelo Mammana, Alessandro Del Maschio, Gianluca Perseghin, Livio Luzi

Research output: Contribution to journalArticlepeer-review


OBJECTIVE - This study examined the metabolic effects of heart transplantation in patients in end-stage cardiac failure. RESEARCH DESIGN AND METHODS - A total of 18 patients after heart transplantation for end-stage heart disease (age 47 ± 3 years; transplant age 5.5 ± 1.5 years; BMI 25.8 ± 0.8 kg/m2; cyclosporin A 4.2 ± 0.6 mg/[kg·day]; azathioprine 0.87 ± 0.31 mg/[kg·day]), 12 patients with type 2 diabetes (D-Tx), and 6 patients without type 2 diabetes (Tx) were studied by means of 1) an oral glucose tolerance test (OGTT) to assess the β-cell secretory response, 2) a euglycemic-hyperinsulinemic (1 mU/[kg·min]) clamp combined with indirect calorimetry and a primed continuous infusion of [6,6-2H2]glucose and [1- 13C]leucine to measure postabsorptive and insulin-stimulated carbohydrate and protein metabolism, and 3) 1H-NMR spectroscopy of the calf muscles to measure intramyocellular triglyceride (IMCL) content. The patients were selected from 480 transplant patients in whom there was a 6% prevalence of type 2 diabetes. Five healthy subjects matched for anthropometric parameters served as control subjects (CON). RESULTS - Tx had postabsorptive and insulin-stimulated glucose, leucine, and free fatty acid metabolism, as well as IMCL content, similar to that of CON. D-Tx were characterized by a reduced secretory response during the OGTT and peripheral insulin resistance with respect to glucose metabolism, which was paralleled by increased plasma free fatty acid concentrations and IMCL content. A defective insulin-dependent suppression of the endogenous leucine flux (index of proteolysis) was also evident during the clamp in D-Tx. CONCLUSIONS - Heart transplantation, notwithstanding the immunosuppressive therapy, was characterized by a normal postabsorptive and insulin-stimulated glucose, leucine, and free fatty acid metabolism in Tx. In contrast, insulin resistance with respect to glucose, free fatty acids, and protein metabolism was present in D-Tx regardless of whether diabetes was preexisting or consequent to heart transplantation.

Original languageEnglish
Pages (from-to)530-536
Number of pages7
JournalDiabetes Care
Issue number3
Publication statusPublished - Mar 2002

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine


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