title: Influence of diabetes on survival in patients with cystic fibrosis before and after lung transplantation.
abstract: BACKGROUND
  The influence of diabetes mellitus (DM) on survival in patients with cystic fibrosis (CF) before and after lung transplantation is not well studied.
  
  
  METHODS
  To determine the influence of DM in patients with CF, the United Network for Organ Sharing database (2005-2013) was queried for 2 cohorts: first-time lung transplant candidates who were not transplanted and first-time transplant recipients.
  
  
  RESULTS
  A total of 679 patients with CF had data on DM status at listing and did not undergo transplantation. In this cohort, DM was associated with significant increase in mortality hazard as shown by an adjusted multivariate Cox model fitted to the whole cohort (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.1-1.8; P = .012) and by a Cox model stratified on pairs of DM and non-DM patients matched on the propensity of having DM at listing (HR, 1.9; 95% CI, 1.2-2.9; P = .003). In comparison, a total of 1464 patients with CF had data on DM status at listing and received a transplant, but DM at listing was not associated with posttransplant survival. The lack of association between DM and mortality hazard was evident in a multivariate Cox regression model fitted to the whole sample (HR, 1.0; 95% CI, 0.82-1.2; P = .98) and a Cox regression model stratified on matched pairs of DM and non-DM patients (HR, 1.1; 95% CI, 0.82-1.5; P = .56).
  
  
  CONCLUSIONS
  The presence of DM is associated with significantly increased risk for death in patients with CF on the wait list before lung transplantation, but does not influence survival after transplantation.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: hayes.705@osu.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Alpa V
authors.initials: AV
authors.lastname: Patel
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Sylvester M
authors.initials: SM
authors.lastname: Black
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Karen S
authors.initials: KS
authors.lastname: McCoy
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kirkby
authors.affiliation: Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Skaggs Pharmaceutical Sciences Center, University of Arizona College of Pharmacy, Tucson, Ariz.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Mansour
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult
keywords: advanced lung disease; cystic fibrosis; diabetes mellitus; lung transplantation; survival