Vascular disease, diabetes among risks in years after lung transplant

Routine monitoring of these patients urged to avoid serious health complications

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Rates of metabolic and cardiovascular complications — from diabetes and kidney issues to hypertension and abnormal blood-fat levels — increased in the years following a lung transplant among people with cystic fibrosis (CF), according to a recent analysis in the Netherlands.

These findings emphasize a need for routine monitoring of transplant patients, its researchers noted. “Early recognition of these complications is crucial and will lead to earlier intervention, which could lead to improved prognosis after lung transplantation,” they wrote.

The study, “The prevalence of vascular and metabolic complications after lung transplant in people with cystic fibrosis in a Dutch cohort,” was published in Clinics.

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Outcomes for CF patients have drastically improved in recent years, in large part due to the emergence of highly effective CFTR modulator therapies and better overall care. One result has been a sharp drop in the number of patients who require a lung transplant.

It’s also likely that patients will need a transplant later in life and live longer after the procedure.

As such, certain long-term complications of CF may become more apparent, particularly metabolic issues such as CF-related diabetes and cardiovascular health.

Understanding the long-term issues that arise post-transplant, the researchers noted, could help to inform early screening and treatment to improve a patient’s prognosis.

Scientists at Leiden University Medical Center examined the prevalence of metabolic and vascular complications for up to 15 years after a lung transplant — compared with pre-transplant status — in 100 CF patients who underwent the procedure at their hospital between 2001 and 2020. They also looked at survival rates, and differences by patients’ sex in reported complications.

Patients had a median age of 31 at the time of transplant and 55% were male, with males also significantly older than female patients.

Researchers noted that pre-transplant data on key clinical measures were not available for all 100 patients, and that not all these people were 15 years out from a lung transplant or still alive.

Among those with measurable changes, all metabolic and vascular complications showed an increasing prevalence over time in the years after a transplant. These included hypertension, vascular (blood vessel) diseases, diabetes, kidney problems, and dyslipidemia, or an imbalance of fats in the blood.

Particularly, CF-related diabetes was found in 63% of these patients before surgery, and rose to affect 89% of them six years later. Likewise, kidney insufficiency was noted in 3% of patients at the time of transplant but was seen in 65% of patients 15 years later.

Dyslipidemia was reported in 21.1% of evaluable patients prior to a lung transplant, rising to affect more than 80% at nine years after the transplant.

Rise in macrovascular diseases likely related to increasing risk factors

Macrovascular complications — issues involving the body’s large blood vessels — occurred in one of 94 evaluable patients prior to a transplant.

Of 82 patients evaluated after the transplant, 13 or 15.9% showed evidence of at least one macrovascular disease: one person had a heart attack, six had strokes, two had heart failure, and six had pulmonary vascular disease, or disease of the blood vessels in the lungs.

Older age and high blood pressure at the time of a transplant associated significantly with a later macrovascular disease risk, the scientists noted, adding that both are also cardiovascular risk factors in the general population.

The rise in macrovascular complications over time also could be related to associated increases in cardiovascular risk factors, such as diabetes, high blood pressure, and abnormal fat levels in the blood.

“In this study, the prevalence of dyslipidemia, [metabolic syndrome], and diabetes also increased significantly” after a lung transplant, the scientists wrote. “With these increments, it would be logical that also the risk for macrovascular disease raised remarkedly.”

Metabolic syndrome is defined as a cluster of co-occurring conditions, from high blood pressure to excess waist fat and blood-fat imbalances — that raise a person’s risk of cardiovascular and other diseases.

Survival rates at one and two years after a transplant were 84% and 80%, respectively, falling to 76% at five years and 58% at 10 years, the study noted. Median survival for these patients was 14 years.

No significant differences were observed between male and female patients across the study, although kidney insufficiency in female patients “trended towards significance,” the scientists noted, suggesting a possible higher risk.

“These data emphasize the necessity of regular check-ups for metabolic and vascular complications after [lung transplant] with specific attention to renal damage, diabetes, and in the diabetic population macrovascular disease,” the researchers concluded. “It is necessary to avoid these check-ups falling behind schedule.”

Further study is needed “to confirm if early recognition leads to improved prognosis and fewer complications,” they added.