Cystic fibrosis‐related diabetes before lung transplantation is associated with lower survival but does not affect long‐term renal function

Abstract

Objective: To describe the prevalence of cystic fibrosis-related diabetes (CFRD) before and after lung transplantation (LT); to analyse the survival and renal function after LT according to the CFRD status before LT. Methods: Sixty cystic fibrosis (CF) patients transplanted at the Lyon UniversityHospital between 2004 and 2014 were included. Genotype, pancreatic status, age at LT, survival were recorded. Glucose tolerance status, daily insulin dose requirement, glomerular filtration rate (GFR), and daily glucocorticoid (GC) dose were recorded before LT and until December 2016.Results: The median follow-up was 5.6 (3.8-8.2) years, and nine patients died. Survival was poorest for patients with CFRD before LT compared with those without CFRD (P = 0.03) but was not correlated with the GFR before LT, with sex, age at LT, or CF genotype. The prevalence of CFRD was 68% at 2 years and 54% at 5 years. For persistent insulin-treated CFRD, the insulin requirement decreased (−2.1 IU/d/y; P < 0.01) and was correlated with the daily GC dose (+0.4 IU/d for one additional milligram, P = 0.012). Seven (11%) patients who had insulin-treated CFRD before LT became nondiabetic after LT, with a median time of 2 (1-4) years. After LT, the GFR decreased (−5.3 ml/min/1.73 m 2 /y; P < 0.001) and was not correlated with the CFRD status before LT.Conclusions: CFRD before LT is associated with poor survival after LT, which should lead to better management of diabetes. Some patients with pre-LT CFRD became nondiabetic after LT. CFRD is not associated with renal insufficiency after LT. K E Y W O R D S cystic fibrosis, cystic fibrosis-related diabetes, lung transplantation, renal function Pediatric Pulmonology. 2019;54:977-983.wileyonlinelibrary.com/journal/ppul

Longitudinal assessment of renal function after lung transplantation for cystic fibrosis: transition from post-operative acute kidney injury to acute kidney disease and chronic kidney failure

“…Cox-proportional hazard models were utilized to evaluate the effects of perioperative AKI and post-operative AKD upon survival. Clinically meaningful variables were included in the model as covariates, based on available literature (i.e., age [17], BMI [18], diabetes [19], gender [20], pulmonary hypertension [21], use of intraoperative ECMO [12], lung allocation score [22], and primary graft dysfunction [23]). Observations were right-censored.…”

Cystic fibrosis foundation consensus statements for the care of cystic fibrosis lung transplant recipients

“…120,124,131 Studies are equivocal regarding the association of pre-transplant CFRD with morbidity and mortality post-transplant. 121,[132][133][134] However, perioperative glycemic control correlates with survival, and should be implemented promptly. 125,135,136 Post-transplant, glycemic management in CFLTRs is complicated by changes in appetite, glucocorticoids, and renal function.…”

Feasibility and efficacy of combined pancreatic islet-lung transplantation in cystic fibrosis-related diabetes–PIM study: A multicenter phase 1–2 trial

“…9,10 The presence of CFRD before transplantation decreases patient survival, while promoting infection and posttransplant pulmonary rejection. 11,12 In posttransplant patients, the prevalence of diabetes was shown to increase, mainly due to the diabetogenic effect of immunosuppressive treatments. 13 For patients with sufficient endogenous insulin production, lung transplantation can improve glycemic control by decreasing insulin resistance.…”

“…For patients requiring lung transplantation, CFRD increases posttransplant morbidity and mortality 9,10 . The presence of CFRD before transplantation decreases patient survival, while promoting infection and posttransplant pulmonary rejection 11,12 . In posttransplant patients, the prevalence of diabetes was shown to increase, mainly due to the diabetogenic effect of immunosuppressive treatments 13 .…”