Lung Transplantation and the Development of Diabetes Mellitus in Adult Patients With Cystic Fibrosis

Navas de Solís, María Soledad; Merino Torres, Juan Francisco; Martínez, Isabel Mascarell; Sellés, Francisco Piñón

doi:10.1016/S1579-2129(07)60029-9

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

It is a monthly journal in which all manuscripts are sent to peer-review and handled by the editor or an associate editor from the team and the final decision is made on the basis of the comments from the expert reviewers and the editors. The journal is published solely in English. All the published data is composed of novel manuscripts not previously published in any other journal and not being in consideration for publication in any other journal..

The journal is indexed at Science Citation Index Expanded, Medline/Pubmed, Embase and SCOPUS. Access to any published article is possible through the journal's web page as well as from Pubmed, ScienceDirect, and other international databases. Furthermore, the journal is also present in X, Facebook and Linkedin. Manuscripts can be submitted electronically using the following web site: https://www.editorialmanager.com/ARBR/.

Indexed in:

Current Contents/Clinical Medicine, JCR SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, SCOPUS, IBECS

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

8.7

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.5

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.464

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.482

View more metrics

Open Access Option

Journal Information

Previous article | Next article

Vol. 43. Issue 2.

Pages 86-91 (February 2007)

More article options

Pages 86-91 (February 2007)

Original Article

DOI: 10.1016/S1579-2129(07)60029-9

Full text access

Lung Transplantation and the Development of Diabetes Mellitus in Adult Patients With Cystic Fibrosis

Visits

4366

Download PDF

María Soledad Navas de Solís, Juan Francisco Merino Torres

Corresponding author

merino_jfr@gva.es

Correspondence: Dr. J.F. Merino Torres. Servicio de Endocrinología y Nutrición. Hospital Universitario La Fe. Avda. Campanar, 21. 46009 Valencia. España

, Isabel Mascarell Martínez, Francisco Piñón Sellés

Servicio de Endocrinología y Nutritión, Hospital Universitario La Fe, Valencia, Spain

This item has received

4366 Visits

Article information

Statistics

Objective

The prevalence of diabetes mellitus is higher in patients with cystic fibrosis than in the general population. Solid organ transplantation is a significant risk factor for diabetes mellitus, which has been linked to type of immunosuppression. The aim of this study was to analyze whether lung transplantation represents a significant risk factor for the onset of abnormal carbohydrate metabolism in cystic fibrosis, whether it affects severity of alterations, and whether there is a relation to type of immunosuppression.

Patients and Methods

The following data were extracted retrospectively for 54 patients with cystic fibrosis: type of carbohydrate metabolism alteration and treatment received, whether or not transplantation took place, and type of immunosuppression used.

Results

Twenty of the 54 patients (37%) underwent lung transplantation; 18 of them (89%) developed diabetes mellitus. Eight of the patients (24%) who did not receive a lung developed diabetes and 10 (29%) displayed carbohydrate intolerance (P<.01, χ2 test). Insulin was administered to 36.3% of nontransplanted patients and 78.6% of transplanted patients. The influence of immunosuppressant used was analyzed in 15 patients. Nine out of 10 patients (90%) treated with cyclosporine and 4 out of 5 (80%) of those treated with tacrolimus developed diabetes mellitus. All received the same regimen of corticosteroid therapy.

Conclusions

For cystic fibrosis patients, lung transplantation is a significant risk factor for developing abnormal carbohydrate metabolism and it influences severity and treatment. No significant differences in the frequency of development of diabetes mellitus were found in relation to type of immunosuppression.

Key words:

Cystic-fibrosis-related diabetes

Diabetes and cystic fibrosis

Post-transplantation diabetes mellitus

Objetivo

La prevalencia de diabetes mellitus (DM) en pacientes con fibrosis quistica (FQ) es mayor que en la poblacion general.

El trasplante de organos solidos es un factor de riesgo importante para el desarrollo de DM y se ha relacionado con el tipo de inmunodepresion. El objetivo del estudio ha sido analizar si el trasplante pulmonar (TP) es un factor de riesgo importante para desarrollar alteracion hidrocarbonada en la FQ, si influye en su gravedad y tratamiento, y si existe relacion con el tipo de inmunodepresion.

Pacientes y Métodos

Se estudio retrospectivamente a 54 pacientes adultos con FQ, sobre los que se recogieron los siguientes datos: tipo de alteracion hidrocarbonada y su tratamiento, existencia o no de TP y tipo de inmunodepresion.

Resultados

De los 54 pacientes, 20 recibieron TP (37%). De estos, el 89% (n = 18) presento DM. Entre aquellos que no recibieron TP, el 24% (n = 8) presento DM y el 29% (n = 10) intolerancia hidrocarbonada (p < 0,01; prueba de χ2). Se pauto insulina al 36,3% de los pacientes sin TP y al 78,6% de los trasplantados. La influencia de la inmunodepresion se analizo en 15 pacientes. Desarrollaron DM el 90% (9/10) de los tratados con ciclosporina y el 80% (4/5) de los tratados con tacrolimus. Todos llevaban la misma pauta de corticoterapia.

Conclusiones

El TP es un factor de riesgo importante para el desarrollo de alteracion hidrocarbonada en pacientes con FQ e influye en su gravedad y tratamiento. No hemos encontrado diferencia significativa entre el tipo de inmunodepresion y la aparicion de DM.

Palabras clave:

Fibrosis quistica

Diabetes relacionada con fibrosis quistica

Diabetes mellitus postrasplante

Full text is only aviable in PDF

REFERENCES

[1]

SM Rowe, S Miller, EJ Sorscher.

Mechanisms of disease: cystic fibrosis.

N Engl J Med, 352 (2005), pp. 1992-2001

http://dx.doi.org/10.1056/NEJMra043184 | Medline

[2]

R Barrio Castellanos, A Cos Blanco, E Garcia Garcia, M Gussinye Canadell, JF Merino Torres, MT Munoz Calvo.

Consenso sobre diagnostico y tratamiento de las alteraciones del metabolismo hidrocarbonado en la fibrosis quistica.

An Esp Pediatr, 53 (2000), pp. 573-579

Medline

[3]

S Tofe, JC Moreno, L Maiz, M Alonso, H Escobar, R Barrio.

Insulin-secretion abnormalities and clinical deterioration related to impaired glucose tolerance in cystic fibrosis.

Eur J Endocrinol, 152 (2005), pp. 241-247

http://dx.doi.org/10.1530/eje.1.01836 | Medline

[4]

JP van Hooff, MH Christiaans, EM van Duijnhoven.

Evaluating mechanisms of post-transplant diabetes mellitus.

Nephrol Dial Transplant, 19 (2004), pp. 8-12

Medline

[5]

M First, D Gerber, S Hariharan, DB Kaufman, R Shapiro.

Posttransplant diabetes mellitus in kidney allograft recipients: incidence, risk factors, and management.

Transplantation, 73 (2002), pp. 379-386

Medline

[6]

D Hadjiliadis, J Madill, C Chaparro, A Tsang, TK Waddell, LG Singer, et al.

Incidence and prevalence of diabetes mellitus in patients with cystic fibrosis undergoing lung transplantation before and after lung transplantation.

Clin Transplant, 19 (2005), pp. 773-778

http://dx.doi.org/10.1111/j.1399-0012.2005.00420.x | Medline

[7]

M Albareda, J Rodriguez-Espinosa, M Murugo, A de Leiva, R Corcoy.

Assessment of insulin sensitivity and beta-cell function from measurements in the fasting state and during an oral glucose tolerance test.

Diabetologia, 43 (2000), pp. 1507-1511

http://dx.doi.org/10.1007/s001250051561 | Medline

[8]

RW Holl, C Buck, C Babka, A Wolf, A Thon.

HbAlc is not recommended as a screening test for diabetes in cystic fibrosis.

Diabetes Care, 23 (2000), pp. 126

Medline

[9]

A Moran, D Hardin, D Rodman, HF Allen, RJ Beall, D Borowitz, et al.

Diagnosis, screening and management of cystic fibrosis related diabetes mellitus. A consensus conference report.

Diabetes Res Clin Pract, 45 (1999), pp. 61-73

Medline

[10]

JA Davidson, A Wilkinson.

On behalf of the International Expert Panel on New-Onset Diabetes After Transplantation. New-onset diabetes after transplantation 2003 International Consensus Guidelines: an endocrinologist's view.

Diabetes Care, 27 (2004), pp. 805-812

Medline

[11]

J Davidson, A Wilkinson, J Dantal, F Dotta, H Haller, D Hernandez, et al.

New-onset diabetes after transplantation: 2003 International Consensus Guidelines.

Transplantation, 75 (2003), pp. 3-24

http://dx.doi.org/10.1097/01.TP.0000043982.08656.81 | Medline

[12]

MP Solomon, DC Wilson, M Corey, D Kalnins, J Zielenski, LC Tsui, et al.

Glucose intolerance in children with cystic fibrosis.

J Pediatr, 142 (2003), pp. 128-132

http://dx.doi.org/10.1067/mpd.2003.5 | Medline

[13]

AD Mackie, SJ Thornton, FP Edenborough.

Cystic fibrosis-related diabetes.

Diabet Med, 20 (2003), pp. 425-436

Medline

[14]

R Barrio Castellanos.

Trastomos en el metabolismo hidrocarbonado en la fibrosis quistica.

Hormona y Factores de Crecimiento, 8 (2005),

[15]

S Quattmcci, M Rolla, G Cimino, S Bertasi, S Cingolani, F Scalercio, et al.

Lung transplantation for cystic fibrosis: 6-year follow-up.

J Cys Fibres, 4 (2005), pp. 107-114

[16]

B Yung, FH Noormohamed, M Kemp, J Hooper, AF Iant, ME Hodson.

Cystic fibrosis-related diabetes: the role of peripheral insulin resistance and beta-cell dysfunction.

Diabet Med, 19 (2002), pp. 221-226

Medline

[17]

DS Hardin, A Ieblanc, G Marshall, DK Seilheimer.

Mechanisms of insulin resistance in cystic fibrosis.

Am J Physiol Endocrinol Metab, 281 (2001), pp. E1022-E1028

Medline

[18]

DS Hardin, A Ieblanc, L Para, DK Seilheimer.

Hepatic insulin resistance and defects in substrate utilization in cystic fibrosis.

Diabetes, 48 (1999), pp. 1082-1087

Medline

[19]

MD Piero Marchetti.

New-onset diabetes after transplantation.

J Heart Lung Transplant, 23 (2004), pp. S194-S201

http://dx.doi.org/10.1016/j.healun.2004.03.007 | Medline

[20]

JA Paolillo, G Boyle, Y Iaw, S Miller, K Iawrence, K Wagner, et al.

Posttransplant diabetes mellitus in pediatric thoracic organ recipients receiving tacrolimus-based immunosuppression.

Transplantation, 71 (2001), pp. 252-256

Medline

[21]

BL Kasiske, JJ Zinder, D Gilbertson, AJ Matas.

Diabetes mellitus after kidney transplantation in the United States.

Am J Transplant, 3 (2003), pp. 178-185

Medline

[22]

O Heisel, R Heisel, R Balshaw, P Keown.

New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis.

Am J Transplant, 4 (2004), pp. 583-595

http://dx.doi.org/10.1046/j.1600-6143.2003.00372.x | Medline

[23]

F Kur, H Reichenspumer, BM Meiser, A Welz, H Fiirst, C Miiller, et al.

Tacrolimus (FK506) as primary immunosuppressant after lung transplantation.

Thorac Cardiovasc Surg, 47 (1999), pp. 174-178

http://dx.doi.org/10.1055/s-2007-1013136 | Medline

[24]

YM Cho, KS Park, HS Jung, HJ Jean, C Ahn, J Ha, et al.

High incidence of tacrolimus-associated posttransplantation diabetes in the Korean renal allograft recipients according to American Diabetes Association criteria.

Diabetes Care, 26 (2003), pp. 1123-1128

Medline

[25]

J Oberholzer, J Thielke, B Hatipoglu, G Testa, HN Sankary, E Benedetti.

Immediate conversion from tacrolimus to cyclosporine in the treatment of posttransplantation diabetes mellitus.

Transplant Proc, 37 (2005), pp. 999-1000

http://dx.doi.org/10.1016/j.transproceed.2004.12.085 | Medline

[26]

M Roy First.

Tacrolimus based immunosuppression.

J Nephrol, 17 (2004), pp. 25-31