Diabetes Greatly Decreases Survival after Lung Transplant

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SAN FRANCISCO—Lung transplant recipients who have diabetes survive half as long as those without diabetes, whether their diabetes began before or after transplantation, a new study finds. The results of the study, conducted in nearly 400 patients, will be presented Saturday at The Endocrine Society’s 95th Annual Meeting in San Francisco.

Diabetes was the strongest risk factor for death after transplantation and carried a fivefold higher risk of dying at any time after the transplant procedure, the study authors found.

“Because diabetes is a potentially modifiable risk factor, our research findings could have a huge impact on patient care—not just in lung but in all organ transplant recipients,” said the study’s principal investigator, Kathryn Hackman, MD, of Monash University and The Alfred Hospital in Melbourne, Australia.

New diabetes is a common problem after lung and other solid-organ transplantation, partly because of the antirejection medications that transplant recipients must take. In addition, diabetes is not uncommon before transplantation. A recent study by Hackman’s group found that a surprisingly large percentage—41 percent—of patients waiting for lung transplants had pre-existing diabetes or prediabetes when screened with an oral glucose tolerance test.

Although earlier studies also have found higher death rates in transplant recipients with diabetes, the current research provides new and more detailed information about diabetes risk in lung transplant recipients, Hackman said.

The researchers reviewed the medical records of 386 patients aged 16 years and older who received lung transplants at The Alfred Hospital between Jan. 1, 2001, and July 31, 2010. They analyzed the data for 367 patients for whom the presence or absence of diabetes was known. Patients with diabetes before transplantation had either Type 2 diabetes or cystic fibrosis-related diabetes.

Nearly 40 percent (68) of 172 transplant recipients without diabetes had died compared with almost 63 percent of patients with diabetes (122 of 195), the authors reported. After the first three post-transplant months, the main cause of death—regardless of diabetes status—was bronchiolitis obliterans syndrome. A form of chronic rejection of the lung transplant, this syndrome occurs from scarring of the small airways in the transplanted lung leading to airway obstruction.

“This finding suggests that diabetes directly affects outcomes of lung transplantation,” Hackman said.

The study found that the time of diabetes diagnosis did not greatly affect survival. Compared with an average survival among nondiabetic patients of 10 years, patients who had diabetes before lung transplantation lived 4.3 years and those in whom diabetes developed after transplantation lived 5 years on average, Hackman reported.

“Our findings suggest that patients who receive lung transplants should be routinely screened for diabetes at regular intervals, especially early after transplant, and their diabetes should be treated,” Hackman said. “Improved management of diabetes in transplant recipients may improve survival following lung transplantation.”

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