Purpose: This study aimed to determine the incidence of solid organ transplant recipients receiving insulin therapy following taper to maintenance corticosteroid dose, which is around the 6-month mark at our institution
Methods: This single-center retrospective study included adult heart or lung transplant recipients
transplanted between September 1, 2023, and September 1, 2024, with at least 6 months of follow-up. Patients with a history of prior or multi-organ solid organ transplantation, or those who did not survive 6 months post-transplant, were excluded. The primary outcome was the proportion of patients remaining on insulin therapy at 6 months post-transplant. Secondary outcomes included use of non-insulin antihyperglycemic agents, median corticosteroid dose at 6 months, incidence of treated acute rejection episodes, occurrence of hyperglycemia-related infections, and HbA1c trends during the follow-up period. Descriptive statistics were used to analyze the baseline characteristics, primary, and secondary outcomes. Time-to-event analysis was performed to evaluate the association between patient subgroups and time to insulin discontinuation.
Results: During the study period, 102 patients were screened and 91 met inclusion criteria (36 heart, 55 lung). Overall, 21% had prior diabetes and 47% had endocrinology follow-up. At 2 weeks post-transplant, 80% of patients required insulin with a median prednisone dose of 30 mg. By 6 months, this declined to 41.8% with a median dose of 10 mg. Time-to-event analysis demonstrated that prior diabetes (log-rank p=0.009) and endocrinology follow-up (p<0.001) were associated with delayed insulin discontinuation. Steroid discontinuation, rejection treatment, and transplant type were not significantly associated with time to insulin discontinuation.
Conclusion: A substantial proportion of patients remained on insulin therapy at the time of steroid weaning, although the incidence declined across successive follow-up periods over the first post-transplant year. This trend likely reflects the progressive reduction in corticosteroid dosing over time following transplantation.
IRB Approval: IRB #859535
