Post-transplant Diabetes Mellitus (PTDM) in lung transplant recipients: Prevalence and outcomes

Background: Post transplant diabetes mellitus (PTDM) is a common sequela of lung transplant (LTx) that has previously been shown to decrease survival.This study evaluates the incidence and outcomes of PTDM following LTx at a single center.Methods: LTx recipients from 2004 through 2013 were retrospectively divided into three groups: (1) No diabetes (DM), (2) Pre-and post-transplant diabetes (PDM), and (3) PTDM.Univariate and multivariate analyses were performed to evaluate risk factors for death following LTx, including pre-transplant diagnosis, body mass index (BMI), Hemoglobin A1C, insulin use, oral anti-diabetes agents (OAD) use, lung allocation score, tacrolimus levels, and serum creatinine (Scr).Results: 293 patients qualified for analysis; 31% had no DM, 17% had PDM and 47% developed PTDM.Median follow-up was 11 years.Survival was not significantly different between groups, although it was shortest in those with PDM.Mean survival was 8.7 years in the no DM group, 7.2 years in PDM, and 8.1 years in PTDM (p=0.09).Scr>2 mg/dL at any time after transplant was the sole predictor of mortality (HR 1.99, CI 1.34-2.96,P<0.01).In PTDM, there was no significant difference in mortality in those with later resolution of DM (29%) versus those with persistent DM (39%) (P=0.22). Conclusion:Nearly half of LTx recipients developed PTDM.However, development of PTDM did not significantly impact mortality.Later resolution of PTDM similarly did not impact mortality.Renal injury with a Scr>2 mg/dL is associated with increased mortality after LTx.