Diabetes increased risk for mortality fivefold after lung transplantation

Issue: August 2013

SAN FRANCISCO — Diabetes could directly affect outcomes related to lung transplantation, Kathryn L. Hackman, MD, of Monash University and The Alfred Hospital in Melbourne, Australia, said during a press conference here at ENDO 2013.

Perspective from Vineeth Mohan, MD

“Diabetes was by far the strongest risk factor for death in lung transplant patients. Survival in patients with diabetes was <5 years vs. 10 years in patients without diabetes,” Hackman said.

She and colleagues conducted a retrospective analysis of 367 patients who underwent lung transplantation between January 2001 and July 2010 at their institution, reporting a significant survival difference between groups (P<.001).

According to Hackman, 67 of the 172 (40%) patients without diabetes died. This group demonstrated a median survival time of 3,677 days, according to data.

Patients with new onset diabetes after lung transplantation had an increased mortality rate of 59% with a median survival time of 1,583 days (95% CI, 222-1,148). Those with pre-and post-lung transplantation diabetes had an increased mortality rate of 49% and a median survival time of 1,834 (95% CI, 1,198-2,470), according to data.

“Irrespective of the presence or absence of other risk factors, patients who had diabetes had five-times the risk of dying than patients who did not have diabetes. Surprisingly, there was no difference in cause of death between patients with and without diabetes. The most common cause of death was chronic rejection of the transplanted lungs. Classically, with diabetes complications we tend to think of heart attacks, strokes, vascular disease, but these patients had no more complications than patients who did not have diabetes,” Hackman said.

Further analyses revealed a 5.6-fold increased risk for mortality in time-dependent diabetes status (95% CI, 4-7.8). Additional predictors included the use of cyclosporin compared with tacrolimus (HR=1.8; 95% CI, 1.2-2.7) and baseline triglycerides (HR=1.6; 95% CI, 1.2-2.1), according to data.

“In summary, lung transplantation is a complex, expensive procedure and organs are of course scarce. At the end of this pretty miraculous surgery, the main cause of mortality is diabetes,” Hackman said. – by Samantha Costa

For more information:

Hackman K. #FP13-6. Presented at: The Endocrine Society Annual Meeting and Expo; June 15-18, 2013; San Francisco.

Disclosure: The researchers report no relevant financial disclosures.

Perspective

Vineeth Mohan, MD

I was very much surprised by the degree of difference in survival in the diabetic population, especially those patients who were recently diagnosed with diabetes after the transplant. I would assume that this would be a prime target for intervention. If we can capture that population and intervene with very straightforward treatments, maybe we can cut that risk substantially. My own hospital started a transplant program, and they’re involving endocrinologists as part of the team, but we’re mainly going to be dealing with liver and kidney. However, I think it emphasizes the relevance of endocrine care in the transplant population.

Vineeth Mohan, MD

Endocrinologist Cleveland Clinic

Weston, FL

Disclosures: Mohan reports no relevant financial disclosures.