A. L. Mardock1, S. E. Rudasill1, Y. Sanaiha1, H. Khoury1, H. Xing1, J. Antonios2, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiothoracic Surgery,Los Angeles, CA, USA 2University Of California – Los Angeles,Los Angeles, CA, USA
Introduction: Diabetes mellitus is among several factors considered when assessing the suitability of donated organs for transplantation. Currently, lungs from diabetic donors (LDDs) are feasible for all eligible recipients. The present study utilized a national database to assess the impact of donor diabetes on the longevity of lung transplant recipients.
Methods: This retrospective study of the United Network for Organ Sharing (UNOS) database analyzed all adult lung transplant recipients from June 2006-December 2015. Donor and recipient demographics including the presence of diabetes were used to create a multivariable model. The primary outcome was five-year mortality, with hazard ratios assessed using multivariable Cox regression analysis. Survival curves were calculated using the Kaplan-Meier method.
Results: Of the 17,843 lung transplant recipients analyzed, 1,203 (12.2%) received LDDs. Recipients of LDDs were more likely to be female (44.1 vs. 40.2%, p<0.01) and have mismatched race (47.5 vs. 42.1%, p<0.01), but otherwise comparable to recipients of non-diabetic lungs. Relative to non-diabetic donors, diabetic donors were older (46.5 vs. 33.6 years, p<0.01), more likely to be female (48.3 vs. 39.1%, p<0.01), and more likely to have a history of smoking (12.2 vs. 9.8%, p<0.01), hypertension (74.6 vs. 19.0%, p<0.01), and higher BMI (28.6 vs. 25.7, p<0.01). Multivariable analysis revealed LDDs to be an independent predictor of mortality at five years (HR 1.16 [1.04-1.29], p<0.01), especially when transplanted to diabetes-free recipients (HR 1.24 [1.11-1.40], p<0.01). Transplantation of LDDs to diabetic recipients showed no independent association with five-year mortality (HR 0.81 [0.63-1.06], p=0.12).
Conclusion: Significantly higher five-year mortality was seen in patients receiving LDDs, particularly among non-diabetic recipients. However, patients with diabetes at the time of transplant who received LDDs saw no decrement in survival compared to those receiving non-diabetic lungs. Therefore, matching non-diabetic recipients to non-diabetic donors may confer a survival benefit and should be considered in lung allocation algorithms.
