Increased Prevalence of Diabetes Mellitus after Lung Transplantation

Introduction: Cardiovascular (CV) disease is a significant cause of mortality after lung transplant. However, the prevalence of diabetes and CV risk factors has not been well-characterized in this setting. Methods: Using an electronic database and chart review, we collected and analyzed retrospective data before and 12-months after lung transplant at our institution between 2010-2016 (n=172). Results: Between pre-transplant and 12-months post-transplant, there were increases in diastolic BP (71.2 vs. 76.5 mmHg, p<0.0001); weight (71.5 vs. 78.8 kg, p <0.0001); BMI (24.5 vs. 27.0 kg/m2, p <0.0001); prevalence of diabetes (21.5% vs. 41.4%, p <0.0001); and prevalence of dyslipidemia (20.9% vs. 30.3%, p <0.0001). Also, more post-transplant patients used long-acting insulin (6.43% vs. 12.90%, p=0.047) and beta-blockers (8.77% vs. 18.71%, 0.0087), but fewer patients took ACE/ARB (23.39% vs. 11.61%, p=0.0055). There were no differences in A1C (6.4% vs. 6.1%, p=0.29), fasting plasma glucose (FPG) (5.96 mmol/L vs. 5.49 mmol/L, p=0.35), or proportion of patients taking metformin (5.85% vs. 2.58%, p=0.15), sulfonylurea (3.51% vs. 0.65%, p=0.075), short-acting insulin (5.85% vs. 9.03%, p=0.27), statin (18.71% vs. 13.55%, p=0.21), any anti-hyperglycemic (13.45% vs. 16.77%, p=0.40), or any anti-hypertensive (36.84% vs. 30.97%, p=0.26). Conclusion: The prevalence of diabetes and CV risk factors observed 12-months after lung transplant was increased compared to pre-transplant. The reasons for this are unclear, but may be related to immunosuppressive medication. Although the prevalence of diabetes is higher after transplant, the lack of differences in A1C and FPG may reflect the greater use of long-acting insulin in post-transplant patients with diabetes. Further study is needed to determine whether these risk factors contribute to an increased risk of adverse clinical outcomes and whether more systematic surveillance and management of these risk factors might mitigate this risk. Disclosure J.M. Leung: None. M. Almehthel: None. N. Partovi: None. J. Yee: None. R. Levy: None. B. Paty: None.