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

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posted on 2023-09-25, 20:13 authored by Maria Stepanova, Ameeta Ravi Kumar, Pamela Brandt, Nagashree Gundurao, Kenneth Cusi, Saleh M. Al-Qahtani, Zobair M. Younossi

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.

Funding

The study was partially funded by the Global NASH Council, the Beatty Liver and Obesity Research Fund, and Center for Outcomes Research in Liver Disease.

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