Effects of Hyperglycemia on Primary Graft Dysfunction in Lung Transplantation

Abstract

Purpose Primary graft dysfunction (PGD) is a significant source of morbidity and mortality. Hyperglycemia is associated with ischemia-reperfusion in mouse models of lung transplant. We hypothesized that perioperative hyperglycemia is associated with grade 3 PGD. Methods and Materials A retrospective review was performed of 125 patients undergoing lung transplant from 2008-2012. The highest blood glucose was recorded preoperatively, intraoperatively, and for 14 days postoperatively. Glucose >160 mg/dL was considered hyperglycemic. PGD was defined as a PaO2/FiO2 ratio Results The incidence of PGD was 16.8% (n=21). Hyperglycemia occurred in 90.4% (n=113) within 48 hours post-transplant while 8% had severe hyperglycemia (>300mg/dL). On univariate and logistic regression analyses, neither the presence nor the degree of hyperglycemia was associated with PGD. However, in a multivariate logistic regression model, preoperative supplemental oxygen (OR 1.24, 95% CI 1.01-1.52, p=0.037) and a low preoperative FEV1 (OR 3.11, 95% CI 1.06-9.15, p=0.040) were risk factors for the development of PGD. On multivariate analysis of secondary outcomes, lactate above 3 mg/dL (HR 1.9, 95% CI 1.24-2.82, p=0.003) and days on an insulin drip (HR 1.11, 95% CI 1.04-1.16, p Conclusions Hyperglycemia occurs frequently in the post-transplant period but was not associated with PGD. Poor preoperative pulmonary function and oxygen use were most significantly associated with PGD while increased days on an insulin drip and high lactate were associated with increased days on mechanical ventilation. These results suggest a group of patients who are more likely to develop PGD and require prolonged ventilatory support in the post-transplant period.