Impact of diabetes mellitus on survival and hospitalization after lung transplantation

Abstract

Introduction: Diabetes mellitus (DM) is a risk factor for mortality and morbidity after solid organ transplantation (kidney, liver). The objective of our study was to determine the effect of DM on survival and unscheduled hospitalizations after lung transplantation. Patients and methods: We included retrospectively 256 patients who received a single or double lung transplantation at Strasbourg University Hospital between 2004 and 2014. The indications for lung transplantation were: COPD (43,4%), cystic fibrosis (21,9%), and pulmonary fibrosis (19,2%). 80% were bilateral transplantations. We grouped the patients into 3 relevant categories of DM: pre- and post-transplant DM, new onset (>3 months) diabetes after transplantation (NODAT) and the control group of non-diabetic patients. Results: 78 patients had pre&post DM and 48 patients developed NODAT. Cystic fibrosis patients had the highest prevalence (50%) of pre&post DM and NODAT. We found a significant difference for unscheduled hospital stays between the 3 groups: the duration of hospital stays [mean±SD] was 86±121 days/year for pre&post DM patients, 50±67 days/year for NODAT, and 78±120 days/year for non-diabetic patients (p=0,032). We observed a worse survival after transplantation in pre&post DM compared to patients without pre-transplant DM (3-months median conditional survival: 6.3 ± 1.6 vs 8.8 ± 0.7 years, p = 0.016). There was no difference in survival for NODAT patients compared to non-diabetic patients (3 months conditional median survival: 10.5 ± 2 years versus 8.4 ± 1.6, NS). Conclusion: DM might have an impact on survival after lung transplantation. An organized and cooperative management of pre&post DM and NODAT seems warranted.