Background and Aim: Type 2 Diabetes (T2D) is a major driver of chronic diseases across the globe. The aim of this study was to assess the impact of T2D on the outcomes of solid organ transplantations.
Method: We used Scientific Registry of Transplant Recipients (SRTR) 2006-2021 to collect data for all patients ≥18 years who received a lung, heart, liver, or kidney single organ transplant in the U.S.
Results: We included 442,100 solid organ transplant recipients: 31,503 lung, 38,004 heart, 86,153 liver, 286,440 kidney transplants. The prevalence of pre-transplant T2D was 15% in lung (increased from 12% in 2006 to 15% in 2021), 26% in heart (22% in 2006 to 28% in 2021), 26% in liver (23% in 2008 to 28% in 2019), and 30% in kidney (26% in 2006 to 34% in 2021). In all organs, post-transplant mortality was significantly higher among transplant recipients with vs. without T2D [lung transplant: 14.2% vs. 13.1% (1 year), 46.4% vs. 42.6% (5 years), p<0.05; heart transplant: 11.2% vs. 9.1% (1 year), 24.4% vs. 20.6% (5 years), all p<0.0001; liver transplant: 10.3% vs. 8.4% (1 year), 25.4% vs. 21.1% (5 years), all p<0.0001; kidney transplant: 5.3% vs. 2.5% (1 year), 20.8% vs. 10.1% (5 years), all p<0.0001]. Independent association of pre-transplant T2D with higher post-transplant mortality was significant after adjustment for clinico-demographic confounders (calendar year, age, sex, race, education, insurance, functional status, obesity, history of cancer, listing diagnosis, donor-related parameters): adjusted hazard ratio (aHR) for T2D in lung transplant recipients =1.08 (1.03-1.13), in heart transplant aHR = 1.26 (1.20-1.32), in liver transplant recipients aHR = 1.26 (1.22-1.30), and in kidney transplant recipients aHR = 1.65 (1.62-1.68) (all p<0.01).
Conclusions: The prevalence of T2D is rapidly increasing in solid organ transplant candidates. In all solid organ transplants, pre-transplant T2D is independently associated with an increased risk of post-transplant mortality, the most profoundly in kidney transplants.
M.Stepanova: None. A.Kumar: None. P.Brandt: None. N.Gundurao: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. Z.Younossi: Consultant; AbbVie Inc., BMS, Gilead Sciences, Inc., Novo Nordisk, Merck & Co., Inc., Quest Diagnostics, Siemens, Intercept Pharmaceuticals, Inc., Viking Therapeutics.
