title: The impact of lungs from diabetic donors on lung transplant recipients†.
abstract: We attempted to determine if transplants of lungs from diabetic donors (DDs) is associated with increased mortality of recipients in the modern era of the lung allocation score (LAS).
  
  
  
  The United Network for Organ Sharing (UNOS) database was queried for all adult lung transplant recipients from 2006 to 2014. Patients receiving a lung from a DD were compared to those receiving a transplant from a non-DD. Multivariate Cox regression analysis using variables associated with mortality was used to examine survival.
  
  
  
  A total of 13 159 adult lung transplants were performed between January 2006 and June 2014: 4278 (32.5%) were single-lung transplants (SLT) and 8881 (67.5%) were double-lung transplants (DLT). The log-rank test demonstrated a lower median survival in the DD group (5.6 vs 5.0 years, P = 0.003). We performed additional analysis by dividing this initial cohort into two cohorts by transplant type. On multivariate analysis, receiving an SLT from a DD was associated with increased mortality (HR 1.28, 95% CI 1.07–1.54, P = 0.011). Interestingly, multivariate analysis demonstrated no difference in mortality rates for patients receiving a DLT from a DD (HR 1.12, 95% CI 0.97–1.30, P = 0.14).
  
  
  
  DLT with DDs can be performed safely without increased mortality, but SLT using DDs results in worse survival and post-transplant outcomes. Preference should be given to DLT when using lungs from donors with diabetes.
authors.affiliation: Department of Surgery, Temple University Hospital, Philadelphia, PA, USA.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Ambur
authors.affiliation: Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.affiliation: Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Senthil
authors.initials: S
authors.lastname: Jayarajan
authors.affiliation: Department of Surgery, Temple University Hospital, Philadelphia, PA, USA.
authors.forename: Sagar
authors.initials: S
authors.lastname: Kadakia
authors.affiliation: Department of Biostatistics, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Huaqing
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA.
authors.forename: Jesus
authors.initials: J
authors.lastname: Gomez-Abraham
authors.affiliation: Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology*; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000379:methods; D066027:Transplant Recipients; D014481:United States / Q000453:epidemiology; D055815:Young Adult