Prior diabetes mellitus is associated with increased morbidity in cystic fibrosis patients undergoing bilateral lung transplantation: an ‘orphan’ area? A retrospective case–control study

Abstract

Almost all cystic fibrosis patients develop hyperglycaemia after lung transplantation, but patients with prior diabetes have more complication-related admissions to hospital and a higher mortality rate.

Diabetes mellitus and survival in cystic fibrosis patients after lung transplantation

“…Few studies have addressed the potential impact of DM on post-transplantation survival in CF. One small study from Sydney found hyperglycaemia postoperatively in almost all CF patients, but more pronounced in DM [6]. In that study, patients with a diagnosis of DM prior to LTx had more hospital admissions, complications and a higher mortality rate after LTx.…”

“…DM is associated with more severe disease and poor health [9], but it is unclear whether it affects survival of CF patients following successful LTx [10,11]. Among two recent studies addressing a potential impact of DM on outcome after LTx, one reported a worse outcome for CF recipients with a preoperative diagnosis of DM, whereas the other found no significant difference between recipients with DM and those without DM [6,10].…”

“…Selection of patients and timing of listing remain difficult choices, and the role of additional morbidities and their management remains unclear [5]. Diabetes mellitus (DM) is a common but treatable condition in CF adolescents and adults and remains a significant morbidity in CF patients following LTx [6]. Development of DM prior to transplantation is associated with poor pulmonary function and increased mortality [7].…”

Diabetes Is a Major Risk Factor for Mortality After Lung Transplantation

“…Further, the mechanisms by which DM increases morbidity and mortality have not been well evaluated. A small study showed that patients with cystic fibrosis (CF) with pretransplant DM who underwent LTx had more hospital re-admissions with infection and likely rejection as well as a higher mortality than patients without DM (13). Another retrospective study showed an association between new onset DM after LTx and acute rejection (14), although this may reflect DM diagnosis in the setting of high dose glucocorticoid therapy used for rejection.…”

Cystic fibrosis-related diabetes: links, challenges, and future directions

“…11 Post-transplant diabetes is common in CF, but the impact of pre-transplant CFRD upon graft survival is not well defined. 12 The mechanisms linking CFRD with inflammation and pulmonary decline have yet to be resolved. In vitro studies identifying increased growth of Staphylococcus aureus and Pseudomonas aeruginosa with increasing airway surface liquid glucose concentration 13,14 support a direct role for hyperglycemia promoting pathogens.…”