Introduction & Objective: Type 2 diabetes (T2D) and associated non-alcoholic steatohepatitis (NASH) or metabolic dysfunction associated steatohepatitis (MASH) can negatively impact outcomes of patients with chronic liver disease (CLD). The aim of this study was to assess the impact of pre-transplant T2D on the outcomes of liver transplantations.

Method: From the Scientific Registry of Transplant Recipients (2007-2022), we selected all adults who received a liver transplant and had listing diagnosis of CLD with or without hepatocellular carcinoma (HCC). The study outcome was time to post-transplant mortality.

Results: We included 104,399 subjects (mean age 56±11 years, 66% male). Considering etiologies of CLD, 3% had chronic hepatitis B, 25% chronic hepatitis C, 20% NASH/MASH, 31% alcoholic liver disease, 22% also had HCC. Of all transplant recipients, 26% had a history of pre-transplant T2D. During follow-up (median=59 months), 27% of liver transplant recipients died, 5% had graft failure. Post-transplant mortality rates were higher in recipients with pre-transplant T2D compared to those without T2D: 10% vs. 8% at 1 year, 26% vs. 21% at 5 years, 45% vs. 37% at 10 years (all p<0.0001). In multivariate survival analysis, pre-transplant T2D was independently associated with higher risk of post-transplant mortality: aHR=1.28 [1.24-1.32]. This remained significant in CLD patients without HCC, aHR=1.30 [1.25-1.35] and those with HCC, aHR=1.23 [1.15-1.31] (all p<0.0001). Other risk factors for increased mortality included older age, male sex, black race, being on life support before transplantation and receiving a re-transplant (p<0.01). There was no association between pre-transplant T2D with an increased risk of graft failure (one-sided p>0.05).

Conclusions: About one quarter of patients receiving liver transplantation in the U.S. have T2D. The presence of pre-transplant T2D is independently associated with an increased risk of post-transplant mortality.

Disclosure

M. Stepanova: None. P. Golabi: None. L. de Avila: None. J. Ong: None. S. Alqahtani: Consultant; AbbVie Inc., Bristol-Myers Squibb Company, Merck & Co., Inc., Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc. Z. Younossi: Consultant; Gilead Sciences, Inc., Bainan Biotech, AbbVie Inc., Bristol-Myers Squibb Company, Abbott, Novo Nordisk, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Siemens Healthcare Diagnostics, Intercept Pharmaceuticals, Inc.

© 2024 by the American Diabetes Association
2024
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