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High prevalence of diabetes before and after lung transplantation: Target for improving outcome?


BACKGROUND: Diabetes increases morbidity and mortality of lung transplantation. However, the reported prevalence of diabetes varies post-transplantation partly due to lack of detection protocols. AIMS: We determined the prevalence of diabetes in patients (i) waitlisted for lung transplant and (ii) early post-transplantation. METHODS: We analyzed patients on the St Vincent's Heart Lung database from 1/4/14 to 30/9/15 on the waitlist (Study 1) and those transplanted (Study 2). Standard of care required all non-diabetic patients to have an oral glucose tolerance test (OGTT) (modified for patients with cystic fibrosis [CF] to screen for CF-related hyperglycemia (CFRH) (plasma glucose >/= 8.2 mmol/L at 60 or 90 minutes). RESULTS: Study 1 included 114 patients (32 with CF, 82 without CF). Twenty-seven of 30 CF patients (90%) with glycemic data had abnormal glucose metabolism: 18 had diabetes and 9 had CFRH. In 50 patients without CF, 20 (40%) had abnormal glucose metabolism; 8 had diabetes and 12 had impaired fasting glucose and/or impaired glucose tolerance. Study 2 included 78 transplanted patients (25 with CF, 53 without CF). Fourteen CF patients had pre-existing diabetes and 7 had pre-existing CFRH. All but 1 patient were diagnosed with diabetes post-transplantation. Hence, diabetes prevalence in CF patients post-transplantation was 96%. Among 53 transplanted patients without CF, 7 (13%) had abnormal glucose metabolism but thirty (57%) were diagnosed with post-transplant diabetes. CONCLUSION: There is a high prevalence of diabetes in lung transplant patients. Earlier endocrine participation in lung transplant services is likely to lower diabetes-related morbidity and mortality further.

Type Journal
ISBN 1445-5994 (Electronic) 1444-0903 (Linking)
Authors Fazekas-Lavu, M.; Reyes, M.; Malouf, M.; Plit, M.; Havryk, A.; Campbell, L. V.; Center, J. R.; Glanville, A. R.; Greenfield, J. R.
Responsible Garvan Author Prof Jerry Greenfield
Published Date 2018-05-09
Status Always Electronic
DOI 10.1111/imj.13963
URL link to publisher's version
OpenAccess link to author's accepted manuscript version