title: Diabetes is a major risk factor for mortality after lung transplantation.
abstract: Survival following lung transplant (LTx) remains significantly lower than after other solid organ transplants. Diabetes mellitus (DM) is a mortality risk factor not comprehensively studied in LTx recipients. Notably, neither the relation of time of DM onset to survival nor the actual causes of DM-associated excess mortality have been described. We determined DM status, DM diagnosis date and all-cause mortality in 386 consecutive adults who underwent LTx at our institution from January 1, 2001 to July 31, 2010. The relationship of DM to survival both as a categorical and time-dependent variable was studied. Fifty-three percent of patients had DM. Overall median survival was 5.2 (95% CI 3.8-6.6) years. At study end, 52% of patients had died, of whom 64% had DM. Estimated median survival was 10 years in patients without DM, 5.0 (3.3-6.8) years in patients with DM pre- and post-LTx and 4.3 (3.1-5.5) years in patients with new onset DM. As a time-dependent covariate, DM was the strongest risk factor for mortality, hazard ratio 3.96 (2.85-5.51). Bronchiolitis obliterans syndrome was the main cause of death in all patients surviving >90 days, but its incidence was not increased in patients with DM. Further studies are warranted to determine whether improved glycemic control could improve outcomes in LTx recipients.
authors.affiliation: Department of Medicine, Monash University, Melbourne, Australia; Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Australia.
authors.forename: K L
authors.initials: KL
authors.lastname: Hackman
authors.forename: M J
authors.initials: MJ
authors.lastname: Bailey
authors.forename: G I
authors.initials: GI
authors.lastname: Snell
authors.forename: L A
authors.initials: LA
authors.lastname: Bach
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008171:Lung Diseases / Q000401:mortality* / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
keywords: Bronchiolitis obliterans syndrome; diabetes mellitus; lung transplantation; mortality; time-dependent analysis