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

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

doi:10.1016/S1579-2129(07)60035-4

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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 quística (FQ) es mayor que en la población general.

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

Pacientes y Métodos

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

Resultados

De los 54 pacientes, 20 recibieron TP (37%). De éstos, el 89% (n = 18) presentó DM. Entre aquellos que no recibieron TP, el 24% (n = 8) presentó DM y el 29% (n = 10) intolerancia hidrocarbonada (p < 0,01; prueba de χ2). Se pautó insulina al 36,3% de los pacientes sin TP y al 78,6% de los trasplantados. La influencia de la inmunodepresión se analizó 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 alteración hidrocarbonada en pacientes con FQ e influye en su gravedad y tratamiento. No hemos encontrado diferencia significativa entre el tipo de inmunodepresión y la aparición de DM.

Palabras clave:

Fibrosis quística

Diabetes relacionada con fibrosis quística

Diabetes mellitus postrasplante

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