Influence of diabetes on survival in patients with cystic fibrosis before and after lung transplantation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 150; no. 3; pp. 707 - 713.e2
• Main Authors: Hayes, Don, MD, MS, Patel, Alpa V., MD, Black, Sylvester M., MD, PhD, McCoy, Karen S., MD, Kirkby, Stephen, MD, Tobias, Joseph D., MD, Mansour, Heidi M., PhD, Whitson, Bryan A., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2015
• Subjects: Adolescent; Adult; advanced lung disease; Cardiothoracic Surgery; Chi-Square Distribution; cystic fibrosis; Cystic Fibrosis - diagnosis; Cystic Fibrosis - mortality; Cystic Fibrosis - surgery; Databases, Factual; diabetes mellitus; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Diabetes Mellitus - mortality; Female; Humans; Kaplan-Meier Estimate; Logistic Models; lung transplantation; Lung Transplantation - adverse effects; Lung Transplantation - mortality; Male; Multivariate Analysis; Propensity Score; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; survival; Time Factors; Tissue and Organ Procurement; Treatment Outcome; United States - epidemiology; Waiting Lists - mortality; Young Adult; United States; 11; 12; CF; cystic fibrosis–related diabetes; United Network for Organ Sharing; body mass index; survival; forced vital capacity; DM; diabetes mellitus; CFRD; lung allocation score; LTx; FVC; FEV 1; cystic fibrosis; advanced lung disease; lung transplantation; UNOS; forced expiratory volume in 1 second; BMI; LAS; FEV1
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2015.06.041

Abstract Background The influence of diabetes mellitus (DM) on survival in patients with cystic fibrosis (CF) before and after lung transplantation is not well studied. Methods To determine the influence of DM in patients with CF, the United Network for Organ Sharing database (2005-2013) was queried for 2 cohorts: first-time lung transplant candidates who were not transplanted and first-time transplant recipients. Results A total of 679 patients with CF had data on DM status at listing and did not undergo transplantation. In this cohort, DM was associated with significant increase in mortality hazard as shown by an adjusted multivariate Cox model fitted to the whole cohort (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.1-1.8; P  = .012) and by a Cox model stratified on pairs of DM and non-DM patients matched on the propensity of having DM at listing (HR, 1.9; 95% CI, 1.2-2.9; P  = .003). In comparison, a total of 1464 patients with CF had data on DM status at listing and received a transplant, but DM at listing was not associated with posttransplant survival. The lack of association between DM and mortality hazard was evident in a multivariate Cox regression model fitted to the whole sample (HR, 1.0; 95% CI, 0.82-1.2; P  = .98) and a Cox regression model stratified on matched pairs of DM and non-DM patients (HR, 1.1; 95% CI, 0.82-1.5; P  = .56). Conclusions The presence of DM is associated with significantly increased risk for death in patients with CF on the wait list before lung transplantation, but does not influence survival after transplantation.