ABSTRACT
Postoperative euglycemic diabetic ketoacidosis (euDKA) associated with sodium-glucose cotransporter-2 (SGLT2) inhibitor use has been well-documented and carries a Food and Drug Administration recommendation to hold SGLT2 inhibitors 3 to 4 days before a planned surgical procedure. Unfortunately, many surgical procedures, such as orthotopic heart transplant (OHT), are unplanned and unpredictable. With the increasing use of SGLT2 inhibitors in diabetic and non-diabetic heart failure patients, new challenges in patient management and perioperative risk have arisen. We report a case in which SGLT2 inhibitor-associated euDKA complicated the postoperative course of a prediabetic patient who had undergone OHT.
Subject(s)
Diabetes Mellitus, Type 2 , Diabetic Ketoacidosis , Heart Transplantation , Prediabetic State , Sodium-Glucose Transporter 2 Inhibitors , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/diagnosis , Glucose , Heart Transplantation/adverse effects , Humans , Sodium , Sodium-Glucose Transporter 2 Inhibitors/adverse effectsABSTRACT
The infectious disease coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. The impact of COVID-19 on solid organ transplantations, including heart transplantation, is currently unclear. Many transplant programs have been forced to swiftly re-evaluate and adapt their practices, leading to a marked decrease in transplants performed. This trend has been due to various factors, including increased donor COVID-19 screening scrutiny and recipient waiting list management in anticipation of COVID-19 critical care surge capacity planning. In the face of these unknown variables, determining when and how to proceed with transplantation in our population of patients with end-stage cardiomyopathies is challenging. Here, we describe our center's experience with orthotopic heart transplantation (OHT) in one of the country's pandemic epicenters, where we performed eight OHTs in the first 2 months after community spread began in late February 2020.
Subject(s)
COVID-19/prevention & control , Heart Failure/surgery , Heart Transplantation , Postoperative Complications/prevention & control , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/etiology , COVID-19 Testing , Female , Humans , Infection Control/methods , Los Angeles/epidemiology , Male , Middle Aged , Pandemics , Perioperative Care/methods , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Treatment OutcomeSubject(s)
Betacoronavirus , Coronavirus Infections/complications , Education, Pharmacy/methods , Organ Transplantation , Pandemics , Pharmacists , Pneumonia, Viral/complications , Transplant Recipients , COVID-19 , Coronavirus Infections/epidemiology , Humans , Pneumonia, Viral/epidemiology , SARS-CoV-2ABSTRACT
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly infecting people worldwide, resulting in the infectious disease coronavirus disease 19 (COVID-19) that has been declared a pandemic. Much remains unknown about COVID-19, including its effects on solid organ transplant (SOT) recipients. Given their immunosuppressed state, SOT recipients are presumed to be at high risk of complications with viral infections such as SARS-CoV-2. Limited case reports in single SOT recipients, however, have not suggested a particularly severe course in this population. In this report, we present a dual-organ (heart/kidney) transplant recipient who was found to have COVID-19 and, despite the presence of a number of risk factors for poor outcomes, had a relatively mild clinical course.
