The Impact of Type 2 Diabetes on the Outcomes of Solid Organ Transplants in the U.S.: Data from a National Registry

Background: Type 2 diabetes (T2D) is a major driver of chronic diseases across the globe. The aim 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 transplant in the U.S. Results: We included 462,692 solid organ transplant recipients: 31,503 lung, 38,004 heart, 106,639 liver, 286,440 kidney transplants. The prevalence of pre-transplant T2D was 15% in lung, 26% in heart, 25% in liver, and 30% in kidney transplant groups, increasing over time. Post-transplant mortality was significantly higher among transplant recipients with T2D vs. those without T2D [lung transplant: 32.1% vs. 29.3% (3 years), 46.4% vs. 42.6% (5 years), p<0.01; heart transplant: 11.2% vs. 9.1% (1 year), 24.4% vs. 20.6% (5 years), p<0.0001; liver transplant: 10.6% vs. 8.9% (1 year), 26.2% vs. 22.0% (5 years), p<0.0001; kidney transplant: 5.3% vs. 2.5% (1 year), 20.8% vs. 10.1% (5 years), p<0.0001]. Independent association of pre-transplant T2D with higher post-transplant mortality was significant after adjustment for clinico-demographic confounders: adjusted hazard ratio (aHR) in lung transplant recipients = 1.08 (1.03-1.13), heart transplant aHR = 1.26 (1.20-1.32), liver transplant aHR = 1.25 (1.21-1.28), kidney transplant aHR = 1.65 (1.62-1.68) (p<0.01). Conclusions: The prevalence of T2D in solid organ transplant candidates is increasing. In all solid organ transplants, pre-transplant T2D is independently associated with higher post-transplant mortality, the most profoundly in kidney transplants.