Hackman Kathryn L, Snell Gregory I, Bach Leon A
1 Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Australia. 2 Department of Medicine, Monash University, Melbourne, Australia. 3 Lung Transplant Service, The Alfred Hospital, Melbourne, Australia.
Transplantation. 2017 Sep;101(9):2200-2206. doi: 10.1097/TP.0000000000001555.
Diabetes mellitus (DM) is associated with increased mortality after transplantation, but the effect of glycemic control on survival is unknown.We sought to determine the relationship between glycemic control (random blood glucose [RBG], fasting blood glucose [FBG], and glycated hemoglobin [HbA1c]) and survival in all lung transplant (LTx) recipients and those with either persistent or no DM.
All 210 LTx recipients from August 1, 2010 to November 1, 2013, were included (median observation 3.0 years). All underwent oral glucose tolerance tests pre-LTx and serially post-LTx. All glucose and HbA1c results from LTx until study end were included, and hazard ratios were calculated.
Of 210 patients, 90 had persistent DM, and 84 had no DM. Overall mortality/repeat LTx was 31%. In the whole cohort, each 1 mM (18 mg/dL) increase in mean FBG and RBG and each 1% increase in mean HbA1c were associated with mortality increases of 18% (95% confidence interval [CI], 5-32%, P = 0.006), 38% (95% CI, 15-65%; P < 0.001), and 46% (95% CI, 15-85%; P = 0.002), respectively. RBG correlated with mortality in the persistent DM and no DM groups, 37% (95% CI, 7-75%; P = 0.012) and 109% (95% CI, 3-323%; P = 0.041) increases/1 mM, respectively).
Glycemic control strongly correlates with survival after LTx. RBG predicted mortality overall and in patients with and without DM. We propose hyperglycemia be managed promptly after LTx.
糖尿病（DM）与移植后死亡率增加相关，但血糖控制对生存率的影响尚不清楚。我们试图确定血糖控制（随机血糖[RBG]、空腹血糖[FBG]和糖化血红蛋白[HbA1c]）与所有肺移植（LTx）受者以及患有持续性糖尿病或无糖尿病患者生存率之间的关系。
纳入2010年8月1日至2013年11月1日期间的所有210例LTx受者（中位观察期3.0年）。所有患者在LTx前均接受口服葡萄糖耐量试验，并在LTx后进行连续检测。纳入从LTx到研究结束的所有血糖和HbA1c结果，并计算风险比。
210例患者中，90例患有持续性糖尿病，84例无糖尿病。总体死亡率/再次LTx率为31%。在整个队列中，平均FBG和RBG每增加1 mM（18 mg/dL），平均HbA1c每增加1%，死亡率分别增加18%（95%置信区间[CI]为5 - 32%，P = 0.006）、38%（95%CI为15 - 65%；P < 0.001）和46%（95%CI为15 - 85%；P = 0.002）。RBG与持续性糖尿病组和无糖尿病组的死亡率相关，分别每增加1 mM，死亡率增加37%（95%CI为7 - 75%；P = 0.012）和109%（95%CI为3 - 323%；P = 0.041）。
血糖控制与LTx后的生存率密切相关。RBG可预测总体死亡率以及糖尿病患者和非糖尿病患者的死亡率。我们建议在LTx后及时处理高血糖。
