Diabetes and other emerging complications in cystic fibrosis before and after lung transplantation

The main conclusions of this thesis are that diabetes is a frequent clinical issue in end-stage CF patients and it is associated with increased mortality after LTx. Causes of this worse survival in patients with CFRD are speculative. One of the major causes of death was early postoperative hemorrhagic shock. We hypothesized this may be due to a higher infection rate pre-transplant for which we found indications on pre-transplant CT-scan. A significantly higher number of periods with intravenous antibiotics for pulmonary infections was shown in patients with CFRD versus patients without CFRD. But CFRD was not an independent factor predicting infection frequency, possibly due to the strict glycemic control achieved. Infection frequency was associated with Pseudomonas aeruginosa colonization and female gender. Both these factors are linked to CFRD in literature and are possibly part of the same causal pathway of CFRD causing infections. Finally, we showed that besides diabetes, also other cardiovascular risk factors are common after LTx, but with as yet unknown clinical consequences.

CF has gone through an evolution from pediatric disease with limited survival due to among others pulmonary disease, to a multi-organ disease in adults due to increased survival and LTx. This requires a multidisciplinary approach with, in case of diabetes, a close collaboration between pulmonologists and endocrinologists to treat CF patients.