Impact of previous cardiovascular disease on the outcome of lung transplantation

Plantier, Laurent; Skhiri, N.; Biondi, Giuseppina; Jébrak, G.; Himbert, Dominique; Castier, Yves; Lesèche, Guy; Mal, Hervé; Thabut, Gabriel; Fournier, Michel

doi:10.1016/j.healun.2010.05.010

Cited by 16 publications

(7 citation statements)

References 17 publications

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“…The increased mortality in patients with DM in our study is consistent with several retrospective studies (5,8,28) and with data from the ISHLT (2). However, a mechanism has not yet been demonstrated.…”

Section: Discussionsupporting

confidence: 92%

Prevalence and Predictors of Diabetes After Lung Transplantation: A Prospective, Longitudinal Study

2014

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OBJECTIVETo determine incidence and prevalence of diabetes mellitus (DM) after lung transplantation (LTx), identify risk factors for persistent DM after LTx, and determine its effect on survival. RESEARCH DESIGN AND METHODSThis was a prospective, longitudinal study comparing DM status before and after LTx using oral glucose tolerance tests (OGTTs). DM prevalence and changes in metabolic control over time were determined. Risk factors for persistent DM and survival differences by DM status were assessed. RESULTSBetween August 2010 and December 2012, 156 patients underwent LTx. DM prevalence after 3, 12, and 24 months was 47%, 44%, and 40%, respectively. A further 20%, 11%, and 7% had impaired glucose tolerance and/or impaired fasting glucose. Incidence of new-onset DM after transplant (NODAT) was 32%, 30%, and 24% after 3, 12, and 24 months. Nonfasting insulin levels and second phase insulin release fell 3 months after transplant (Tx) but returned to baseline by 2 years. The only risk factors for NODAT were 1-and 2-h glucose levels on pre-Tx OGTT (OR 1.73 [95% CI 1.19-2.50], P = 0.004, and 1.84 [1.22-2.77], P = 0.004, respectively). Survival was reduced in patients with DM at study end versus those without (estimated mean 979 days [95% CI 888-1,071] vs. 1,140 days [1,070-1,210], P = 0.023). CONCLUSIONSMost patients had dysglycemia during the first year after LTx, and 32% developed NODAT. Hyperglycemia was caused both by b-cell dysfunction and by insulin resistance. Only pre-Tx OGTT glucose levels predicted persistent NODAT. As DM was common and associated with reduced survival, early detection and management of DM in LTx recipients are warranted.Diabetes mellitus (DM) is a common complication of solid organ transplantation and is associated with increased morbidity and mortality (1). It is especially common after lung transplantation (LTx), firstly because LTx recipients (LTR) require highdose immunosuppression with glucocorticoids in combination with calcineurin inhibitors and secondly because a significant minority of patients have cystic fibrosis (CF), which results both in lung damage necessitating LTx and in destruction of insulin-producing b-cells in the pancreas.

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Section: Discussionsupporting

confidence: 92%

Prevalence and Predictors of Diabetes After Lung Transplantation: A Prospective, Longitudinal Study

2014

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“…The only previous study to determine the effect of DM in a broad group of LTx recipients assessed the effect of pretransplant cardiovascular disease on posttransplant mortality (25). In that study, only pretransplant DM, defined by hypoglycemic agent use, was considered and it conferred a HR of 2.8.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Is a Major Risk Factor for Mortality After Lung Transplantation

Hackman

Bailey

Snell

et al. 2014

American Journal of Transplantation

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Survival following lung transplant (LTx) remains significantly lower than after other solid organ transplants. Diabetes mellitus (DM) is a mortality risk factor not comprehensively studied in LTx recipients. Notably, neither the relation of time of DM onset to survival nor the actual causes of DM-associated excess mortality have been described. We determined DM status, DM diagnosis date and all-cause mortality in 386 consecutive adults who underwent LTx at our institution from January 1, 2001 to July 31, 2010. The relationship of DM to survival both as a categorical and time-dependent variable was studied. Fifty-three percent of patients had DM. Overall median survival was 5.2 (95% CI 3.8-6.6) years. At study end, 52% of patients had died, of whom 64% had DM. Estimated median survival was 10 years in patients without DM,) years in patients with DM pre-and post-LTx and 4.3 (3.1-5.5) years in patients with new onset DM. As a timedependent covariate, DM was the strongest risk factor for mortality, hazard ratio 3.96 (2.85-5.51). Bronchiolitis obliterans syndrome was the main cause of death in all patients surviving >90 days, but its incidence was not increased in patients with DM. Further studies are warranted to determine whether improved glycemic control could improve outcomes in LTx recipients.

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“…[33][34][35]37 Similarly, conditions such as left ventricular hypertrophy, 66,67 low glomerular filtration rate, 71 hypertriglyceridemia, 72 hypercholesterolemia 72 ; malnutrition-related factors such as low albumin 62,63 or intramuscular adipose tissue content 75 ; and psoas muscle mass index 75 or low muscle mass 60,75 emerged as important risk factors for liver transplant. Conditions such as atrial fibrillation, 80 carotid atheroma, 80 stroke risk, 82 pancreatic insufficiency, 81 and infections 23,81 were risk factors for lung transplant. Conditions such as congestive heart failure 43 and proteinuria 52 were important risk factors for pancreas transplant.…”

Section: Practical Implicationsmentioning

confidence: 99%

A Systematic Review for Variables to Be Collected in a Transplant Database for Improving Risk Prediction

et al. 2019

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Background. This systematic review was commissioned to identify new variables associated with transplant outcomes that are not currently collected by the Organ Procurement and Transplantation Network (OPTN). Methods. We identified 81 unique studies including 1 193 410 patients with median follow-up of 36 months posttransplant, reporting 108 unique risk factors. Results. Most risk factors (104) were recipient related; few (4) were donor related. Most risk factors were judged to be practical and feasible to routinely collect. Relative association measures were small to moderate for most risk factors (ranging between 1.0 and 2.0). The strongest relative association measure for a heart transplant outcome with a risk factor was 8.6 (recipient with the previous Fontan operation), for a kidney transplant 2.8 (sickle cell nephropathy as primary cause of end-stage renal disease), for a liver transplant 14.3 (recipient serum ferritin >500 µg/L), and for a lung transplant 6.3 (Burkholderia cepacia complex infection for 1 y or less). OPTN may consider some of these 108 variables for future collection to enhance transplant research and clinical care. Conclusions. Evidence-based approaches can be used to determine variables collected in databases and registries. Several candidate variables have been identified for OPTN.

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Impact of previous cardiovascular disease on the outcome of lung transplantation

Cited by 16 publications

References 17 publications

Prevalence and Predictors of Diabetes After Lung Transplantation: A Prospective, Longitudinal Study

Prevalence and Predictors of Diabetes After Lung Transplantation: A Prospective, Longitudinal Study

Diabetes Is a Major Risk Factor for Mortality After Lung Transplantation

A Systematic Review for Variables to Be Collected in a Transplant Database for Improving Risk Prediction

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