Klomjit Nattawat, Mehrnia Alireza, Sampaio Marcelo, Bunnapradist Suphamai
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Clin Transpl. 2015;31:43-55.
There are limited data on the outcome of diabetic lung recipients, especially in those with new-onset diabetes after transplantation (NODAT).
We studied prevalence of pre-transplant diabetes mellitus (PDM) and cumulative incidence of NODAT in lung recipients using the Organ Procurement and Transplantation Network /United Network for Organ Sharing database. Between 2004 and 2011, adult (≥18 years old) recipients transplanted with either first single- or double-lung were included. Those who lacked a diabetes record or received multi-organ transplants were excluded. Patient survival were studied in recipients who had functioning grafts for at least one year.
There were 10,226 recipients who had at least one diabetes record, the prevalence of PDM was 18.25% and the cumulative incidence of NODAT during the five years post-transplant was 39.43%. Of 9,117 recipients who had functioning grafts for at least one year, adjusted hazard ratios (HR) of PDM and NODAT, compared to the diabetes-free group, were 1.12 (p=0.048) and 1.12 (p=0.025), respectively. Independent risk factors for mortality included the presence of rejection in the one year, cytomegalovirus serology donor positive/recipient negative, and recipient age >60 years. Among recipients with cystic fibrosis, there was no statistical difference in mortality between diabetic recipients and the diabetes-free group. Compared to the diabetes-free group, the adjusted HRs for mortality of PDM and NODAT in recipients without cystic fibrosis were 1.15 (p=0.031) and 1.14 (p=0.011), respectively.
Diabetes was associated with mortality in lung transplant recipients overall and in lung recipients without cystic fibrosis. However, there was no association between diabetes and mortality in lung recipients with cystic fibrosis.
关于糖尿病肺移植受者的预后数据有限，尤其是那些移植后新发糖尿病（NODAT）的患者。
我们使用器官获取与移植网络/器官共享联合网络数据库研究了肺移植受者移植前糖尿病（PDM）的患病率和NODAT的累积发病率。纳入2004年至2011年间接受首次单肺或双肺移植的成年（≥18岁）受者。排除那些缺乏糖尿病记录或接受多器官移植的患者。对移植后至少有一年功能良好移植物的受者的患者生存率进行了研究。
有10226名受者至少有一次糖尿病记录，PDM的患病率为18.25%，移植后五年内NODAT的累积发病率为39.43%。在9117名移植后至少有一年功能良好移植物的受者中，与无糖尿病组相比，PDM和NODAT的调整后风险比（HR）分别为1.12（p=0.048）和1.12（p=0.025）。死亡的独立危险因素包括一年内出现排斥反应、巨细胞病毒血清学供体阳性/受者阴性以及受者年龄>60岁。在患有囊性纤维化的受者中，糖尿病受者和无糖尿病组之间的死亡率无统计学差异。与无糖尿病组相比，无囊性纤维化受者中PDM和NODAT的死亡率调整后HR分别为1.15（p=0.031）和1.14（p=0.011）。
糖尿病与总体肺移植受者以及无囊性纤维化的肺移植受者的死亡率相关。然而，糖尿病与患有囊性纤维化的肺移植受者的死亡率之间没有关联。
