FP13-6 Diabetes Is the Major Risk Factor for Mortality in Lung Transplant Recipients

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP13-GI Peptides, Beta Cells & Glycemia
Translational
Saturday, June 15, 2013: 11:00 AM-11:30 AM
Presentation Start Time: 11:25 AM
Room 304 (Moscone Center)

Poster Board SAT-839
Kathryn Lisa Hackman*1, Gregory Snell2 and Leon Bach3
1Monash University, Melbourne, Australia, 2The Alfred Hospital, Melbourne, Australia, 3The Alfred, Melbourne, Australia
Diabetes (DM) is a known risk factor for mortality following lung transplantation (LTx) but few studies have systematically determined DM status both before and after LTx and assessed its effect on survival.

All 386 patients who underwent LTx at our institution between 1/1/2001 – 31/7/2010 were retrospectively assessed for DM using patient files and all available pathology test results. We categorised all patients’ DM status prior to and following LTx. Patients whose DM status was unknown (n= 9) or who had transient DM that then resolved (n= 10) were excluded from analyses. Kaplan-Meier and multivariate Cox regression analyses were used to assess median survival of the remaining 367 patients according to diabetes category and to determine whether DM independently affected survival after allowing for other risk factors.

There was a significant difference in survival between groups (p < 0.001). Sixty-seven of the 171 patients without DM died (39%). Estimated median survival in this group was 3677 days. Patients with new onset DM post LTx and those with pre- and post-LTx DM respectively had increased mortality rates of 59% and 49%, and significantly shorter median survivals of 1583 (CI 222-1148) and 1834 (CI 1198 – 2470) days.

On multivariate analysis, time-dependent DM status was the strongest predictor of mortality, conferring a 5.6-fold increased risk of mortality (95% CI 4.0-7.8, p <0.001). Other predictors were use of cyclosporin rather than tacrolimus (HR 1.8, 95% CI 1.2-2.7, p= 0.005) and baseline triglycerides (HR 1.6, CI 1.2-2.1, p<0.001). Protective factors were negative donor/recipient CMV status (HR 0.6, CI 0.4–0.9, p = 0.018) and underlying cystic fibrosis or bronchiectasis (HR 0.5, CI 0.4-0.8, p<0.001). In contrast, duration on LTx waitlist, smoking history, age, sex and BMI did not predict survival. Cause of death did not differ significantly in relation to DM status, and bronchiolitis obliterans (BOS) was the main cause, accounting for half of all deaths occurring after the first 3 months.

Diabetes is an important and potentially modifiable risk factor for mortality following lung transplantation. The minimal difference in survival between patients with pre-transplant vs new-onset DM post-LTx suggests that post transplant hyperglycaemia may have relatively rapid effects. It is possible that hyperglycaemia hastens the development of BOS. Further studies are warranted to investigate the effect of glycaemic control on lung transplant outcome.

Nothing to Disclose: KLH, GS, LB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: KLH received a Monash Faculty Postgraduate Scholarship and an Alfred Research Trusts Postgraduate Scholarship.
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