High blood sugar linked with higher mortality for lung transplant patients

Dr Kathryn Hackman, lead author of the study, explaining how
diabetes halves survival after lung transplant. 2013 Video

by Anne Crawford

Lung transplant recipients with hyperglycemia (high blood sugar levels) face a significantly greater risk of mortality than those with normal glucose levels, a study by Monash University, Central Clinical School (CCS) and Alfred Hospital researchers has found.



Diabetes is known to be associated with increased mortality following lung transplantation, but this is the first research to establish a link between high glucose levels per se and increased mortality in these recipients.

The study – led by Alfred endocrinologist Dr Kathryn Hackman, who completed her PhD in CCS in 2014 – followed 210 adult patients who had transplants at The Alfred from 1 August 2010 to 1 November 2013 for up to five years, to try to tease out the relationship between glycemic control and survival. It found that blood glucose levels predicted mortality in patients both with and without diabetes. The authors say that further research is urgently required and recommend that hyperglycemia be managed promptly after transplant.

“We still haven’t absolutely proved that it’s the high glucose that’s causing the increased death rate but our reasoning at the moment is that it’s feasible and all the evidence is supporting that,” said Professor Leon Bach, Deputy Director of Endocrinology and Diabetes. Professor Bach and the head of The Alfred’s lung transplantation team Professor Greg Snell supervised Dr Hackman’s work.

The findings add to a body of evidence gleaned from research that started many years ago after Professor Bach realised that little was known about diabetes and lung transplantation. Despite improvements with the procedure and long-term postoperative care, outcomes for lung transplants remain inferior to those of other solid organs such as the heart, kidney and pancreas.

The researchers previously found that diabetes was associated with a four-fold increase in death rates among lung transplant patients, who either already had the disease or who developed persistent diabetes as a consequence of immune-suppressing medication including steroids.

“What we’ve shown is that diabetes is really important, at the very least it’s a marker of increased risks. The good news is that we have effective methods of treating diabetes,” Professor Bach said.

The research has led to the screening and management of patients with diabetes on The Alfred’s lung transplant waiting list. Dr Hackman now works as a clinician attached to the transplantation unit managing its patients with diabetes, and a diabetes educator was recently employed at the clinic.

“There’s been a significant shift, at least in our unit, of increased recognition of diabetes,” Professor Bach said. “We hope this will spread to other hospitals. The transplant unit is one of the largest worldwide – we have a voice,” he said.

The findings also have direct relevance to current management of other solid organ transplant recipients, the study said.

Hackman KL, Snell GI, Bach LA. Poor Glycemic Control is Associated with Decreased Survival in Lung Transplant Recipients. Transplantation. 2016 Oct 28. [Epub ahead of print]

Kathryn spoke about her research in the "Three Minute Thesis" competition in 2013. She won the CCS school heat and earned third place at the Faculty final.