Diabetes Is a Major Risk Factor for Mortality After Lung Transplantation

Survival following lung transplant (LTx) remains significantly lower than after other solid organ transplants. Diabetes mellitus (DM) is a mortality risk factor not comprehensively studied in LTx recipients. Notably, neither the relation of time of DM onset to survival nor the actual causes of DM‐associated excess mortality have been described. We determined DM status, DM diagnosis date and all‐cause mortality in 386 consecutive adults who underwent LTx at our institution from January 1, 2001 to July 31, 2010. The relationship of DM to survival both as a categorical and time‐dependent variable was studied. Fifty‐three percent of patients had DM. Overall median survival was 5.2 (95% CI 3.8–6.6) years. At study end, 52% of patients had died, of whom 64% had DM. Estimated median survival was 10 years in patients without DM, 5.0 (3.3–6.8) years in patients with DM pre‐ and post‐LTx and 4.3 (3.1–5.5) years in patients with new onset DM. As a time‐dependent covariate, DM was the strongest risk factor for mortality, hazard ratio 3.96 (2.85–5.51). Bronchiolitis obliterans syndrome was the main cause of death in all patients surviving >90 days, but its incidence was not increased in patients with DM. Further studies are warranted to determine whether improved glycemic control could improve outcomes in LTx recipients. A multivariate analysis of all patients undergoing lung transplantation in one center over a 10‐year period shows that diabetes status is a major risk factor for mortality.