Organized Management of Diabetes Mellitus in Lung Transplantation: Study of Glycemic Control and Patient Survival in a Single Center

Chronic kidney disease after lung transplantation in a changing era

“…Besides older age and cardiovascular disease, traditional CKD risk factors such as diabetes mellitus (DM), hypertension, dyslipidemia and previous smoking status are common in the LTx population. Pretransplantation DM is common and ranges from 21 to 29% for the total LTx population with a higher prevalence of 40-50% in cystic fibrosis (CF) patients [8][9][10].The prevalence of post-transplantation DM (PTMD) is high and currently increasing, probably related to older age, increasing weight and calcineurin inhibitor toxicity [11].The incidence Abbreviations: ACR, Albumin creatinine ratio; AER, Albumin excretion rate; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration, Research Group; CLAD, Chronic lung allograft dysfunction; CNI, Calcineurin-inhibitor; ECMO, Extracorporeal membrane oxygenation; eGFR, Estimated glomerular filtration rate; ESRD, End-stage renal disease; GLP-1 agonist, Glucagon-like peptide-1 agonist; HRQoL, Health related quality of life; HTx, Heart transplantation; IMV, Invasive mechanical ventilation; KDIGO, Kidney disease: improving global outcomes; LAS, Lung allocation score; LCP tacrolimus, Extended-release tacrolimus; LTx, Lung transplantation; mGFR, Measured glomerular filtration rate; nonsteroidal MRA, Nonsteroidal mineralocorticoid receptor antagonist; mTORi, Mammalian target of rapamycin inhibitors; PCR, Protein creatinine ratio; PER, Protein excretion rate; PR tacrolimus, Prolonged-release tacrolimus; RAS, Renin-angiotensin-aldosterone system; SGLT2i, Sodium-glucose co-transporter-2 inhibitor; SOT, Solid organ transplantation.…”

Recipient Management before Lung Transplantation

“…Although diabetes mellitus (DM) is not a contraindication to lung transplantation, existing studies found that pre-transplantation DM was associated with an increased risk of mortality [ 39 , 40 ]. Most transplantation centers recommend that blood glucose be well controlled (e.g., hemoglobin A1C of 7% or less).…”

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

“…118 After transplant, diabetes mellitus is common; up to 80% of cases diagnosed within 6 months post-transplant. [119][120][121][122][123][124][125] Current guidelines for CFRD recommend that glucose should be monitored closely after surgery, and that individuals without a diagnosis of diabetes be screened annually with an OGTT. 118 Glycosylated hemoglobin (A1C) is not recommended for screening as this may not differ significantly between those with and those without CFRD.…”

“…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. 124,125 CFTLR's with CFRD are insulin-deficient, thus insulin is the only recommended therapy.…”

“…125,135,136 Post-transplant, glycemic management in CFLTRs is complicated by changes in appetite, glucocorticoids, and renal function. 124,125 CFTLR's with CFRD are insulin-deficient, thus insulin is the only recommended therapy. Insulin use pre-transplant is associated with improved BMI and lung function, decreased hospitalizations and mortality.…”