Background: Although transplantation is known to impair glucose tolerance, evolution of pre-existing diabetes after lung transplantation (LT) in cystic fibrosis (CF) has never been described. Objectives: We aimed to assess the outcome of CF-related diabetes (CFRD) after LT, with the hypothesis that suppressing chronic inflammatory foci may improve glucose tolerance in some patients. Methods: In a retrospective study of 29 CF diabetic patients treated with insulin and undergoing LT, CFRD control was assessed 3 months before LT and 1 (n = 27) and 2 (n = 18) years after LT by measuring insulin dosage, fasting blood glucose and glycosylated hemoglobin (HbA1c) levels. Patients with HbA1c ≤7% and an insulin dose ≤1 UI/kg/day were defined as having controlled CFRD (group A). Other patients were assigned to group B. Results: Before LT, 19 (65.5%) patients were in group A. At 2 years, 6 of 10 (60%) patients who were in group B prior to LT had moved into group A, which then comprised 77.8% of all patients. Insulin could have been stopped in 5 patients. Uncontrolled CFRD before LT (OR = 16) and a long delay between the diagnosis of CFRD and LT (OR = 1.3) were significant predictors of uncontrolled CFRD at 1 year. Conclusions: LT does not seem to worsen CFRD in some patients, suggesting that in some cases, glucose tolerance may be improved by the suppression of chronic pulmonary infection.

Keywords:
Cystic fibrosis, Diabetes mellitus, Lung transplantation
1.
O'Sullivan BP, Freedman SD: Cystic fibrosis. Lancet 2009;373:1891-1904.
2.
Brennan AL, Geddes DM, Gyi KM, Baker EH: Clinical importance of cystic fibrosis-related diabetes. J Cyst Fibros 2004;3:209-222.
3.
Nathan BM, Laguna T, Moran A: Recent trends in cystic fibrosis-related diabetes. Curr Opin Endocrinol Diabetes Obes 2010;17:335-341.
4.
Moran A, Dunitz J, Nathan B, Saeed A, Holme B, Thomas W: Cystic fibrosis-related diabetes: current trends in prevalence, incidence, and mortality. Diabetes Care 2009;32:1626-1631.
5.
Buzzetti R, Salvatore D, Baldo E, Forneris MP, Lucidi V, Manunza D, Marinelli I, Messore B, Neri AS, Raia V, Furnari ML, Mastella G: An overview of international literature from cystic fibrosis registries. 1. Mortality and survival studies in cystic fibrosis. J Cyst Fibros 2009;8:229-237.
6.
Christie JD, Edwards LB, Aurora P, Dobbels F, Kirk R, Rahmel AO, Stehlik J, Taylor DO, Kucheryavaya AY, Hertz MI: The Registry of the International Society for Heart and Lung Transplantation: twenty-sixth official adult lung and heart-lung transplantation report - 2009. J Heart Lung Transplant 2009;28:1031-1049.
7.
Mordant P, Bonnette P, Puyo P, Sage E, Grenet D, Stern M, Fischler M, Chapelier A: Advances in lung transplantation for cystic fibrosis that may improve outcome. Eur J Cardiothorac Surg 2010;38:637-643.
8.
Brennan AL, Gyi KM, Wood DM, Hodson ME, Geddes DM, Baker EH: Relationship between glycosylated haemoglobin and mean plasma glucose concentration in cystic fibrosis. J Cyst Fibros 2006;5:27-31.
9.
Holl RW, Buck C, Babka C, Wolf A, Thon A: Hba1c is not recommended as a screening test for diabetes in cystic fibrosis. Diabetes Care 2000;23:126.
10.
Yung B, Noormohamed FH, Kemp M, Hooper J, Lant AF, Hodson ME: Cystic fibrosis-related diabetes: the role of peripheral insulin resistance and beta-cell dysfunction. Diabet Med 2002;19:221-226.
11.
Hardin DS, Leblanc A, Marshall G, Seilheimer DK: Mechanisms of insulin resistance in cystic fibrosis. Am J Physiol 2001;281:E1022-E1028.
12.
Fernandez-Real JM, Ricart W: Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev 2003;24:278-301.
13.
Kimberly RP: Glucocorticoids. Curr Opin Rheumatol 1994;6:273-280.
14.
Hadjiliadis D, Madill J, Chaparro C, Tsang A, Waddell TK, Singer LG, Hutcheon MA, Keshavjee S, Elizabeth Tullis D: Incidence and prevalence of diabetes mellitus in patients with cystic fibrosis undergoing lung transplantation before and after lung transplantation. Clin Transplant 2005;19:773-778.
15.
Rosenblatt RL: Lung transplantation in cystic fibrosis. Respir Care 2009;54:777-786.
16.
Letko E, Bhol K, Pinar V, Foster CS, Ahmed AR: Tacrolimus (fk 506). Ann Allergy Asthma Immunol 1999;83:179-189.
17.
Navas de Solis MS, Merino Torres JF, Mascarell Martinez I, Pinon Selles F: Lung transplantation and the development of diabetes mellitus in adult patients with cystic fibrosis. Arch Bronconeumol 2007;43:86-91.
18.
Fridell JA, Wozniak TC, Reynolds JM, Powelson JA, Hollinger EF, Duncan MW, Sannuti A, Milgrom ML: Bilateral sequential lung and simultaneous pancreas transplant: a new approach for the recipient with cystic fibrosis. J Cyst Fibros 2008;7:280-284.
19.
Vantyghem MC, Kerr-Conte J, Arnalsteen L, Sergent G, Defrance F, Gmyr V, Declerck N, Raverdy V, Vandewalle B, Pigny P, Noel C, Pattou F: Primary graft function, metabolic control, and graft survival after islet transplantation. Diabetes Care 2009;32:1473-1478.
20.
Tschopp JM, Brutsche MH, Frey JG, Spiliopoulos A, Nicod L, Rochat T, Morel P: End-stage cystic fibrosis: improved diabetes control 2 years after successful isolated pancreatic cell and double-lung transplantation. Chest 1997;112:1685-1687.
21.
Badet L, Benhamou PY, Wojtusciszyn A, Baertschiger R, Milliat-Guittard L, Kessler L, Penfornis A, Thivolet C, Renard E, Bosco D, Morel P, Morelon E, Bayle F, Colin C, Berney T: Expectations and strategies regarding islet transplantation: metabolic data from the GRAGIL 2 trial. Transplantation 2007;84:89-96.
22.
Kessler L, Greget M, Metivier AC, Moreau F, Bosco D, Santelmo N, Helms O, Pinget M, Berney T, Massard G, Kessler R: Combined pancreatic islet-lung transplantation with islet percutaneous portal embolization in cystic fibrosis. Transplantation 2008;85:1670-1671.
23.
Kanj SS, Tapson V, Davis RD, Madden J, Browning I: Infections in patients with cystic fibrosis following lung transplantation. Chest 1997;112:924-930.
© 2012 S. Karger AG, Basel
2012
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