Diabetes Tied to Higher Death Risk After Solid Organ Transplant

CHICAGO — Diabetes was linked with an increased risk of death among transplant recipients of four major organs, with pre-existing and new-onset diabetes both implicated, a comprehensive analysis of four types of solid-organ transplant recipients suggested.

Compared with recipients who never had diabetes, those who developed new-onset diabetes after transplantation (NODAT) had a significantly higher risk of mortality over a 10-year follow-up, reported Mishal Ali, BA, of the University of Chicago.

Mortality risk was highest in heart recipients with NODAT (HR 1.29, 95% CI 1.24-1.34), followed by liver (HR 1.17, 95% CI 1.14-1.21), kidney (HR 1.12, 95% CI 1.09-1.14), and lung recipients (HR 1.07, 95% CI 1.03-1.12), Ali reported at ENDO 2026, the annual meeting of the Endocrine Society.

Most NODAT cases developed within the first 5 years after transplant, which Ali called the window for clinical intervention. After 15 years, over a quarter of lung (27.5%) and nearly a quarter of heart (22.6%) recipients developed NODAT.

Ali noted that among “our thoracic recipients, one in four of them will develop diabetes post-transplant at some point in their life.”

“Diagnosis of diabetes in this particular population is genuinely difficult because chronic inflammation alters your glucose readings,” she explained. The main drivers of NODAT include steroids, calcineurin inhibitors, and lifestyle changes.

Pre-existing diabetes was also tied to a higher mortality risk in organ transplant recipients. Risk was highest in kidney transplant recipients with pre-existing diabetes, who had nearly 90% higher risk for death. Heart and liver recipients with pre-existing diabetes had roughly 20% higher mortality risks.

By year 10, 25.1% more kidney transplant recipients who had pre-existing diabetes had died compared with patients who never had diabetes. Ten-year survival rates also differed by 11.7% in liver recipients and 10.9% in heart recipients. Lung recipients did not have a mortality difference due to their high baseline mortality.

Rates of pre-existing diabetes at the time of transplant are rising, Ali pointed out. As of 2020, an estimated 37% of kidney recipients had diabetes at the time of transplant, followed by 26% of liver recipients, 25% of heart, and 17% of lung recipients.

“What prior literature tells us is that the link between diabetes and mortality is very clearly established, but it’s been very specific to a single-organ focus. And even within the single-organ results, the reported NODAT incidence varies very significantly,” said Ali.

Until this study, there hasn’t been a head-to-head cross-organ comparison in one single cohort, she noted.

For the national analysis, 732,381 single-organ transplant recipients were pulled from the Organ Procurement and Transplantation Network (OPTN) and Standard Transplant Analysis Research (STAR) registries. The registries have every solid-organ transplant performed in the U.S. since 1987, tracking recipient, donor, and longitudinal follow-up, including diabetes status at each visit. Models were adjusted for age, BMI, gender, and transplant year.

The researchers also looked at intestine transplant recipients, but data were sparse.

When both types of diabetes were compared, those with pre-existing diabetes prior to transplant generally had higher risks of death. Kidney recipients had the largest delta; those with pre-existing diabetes had an 87% higher risk of death compared with non-diabetics, whereas those with NODAT had a 12% higher risk.

“Transplant providers should monitor closely for current and new-onset diabetes. Because of the differential effect of diabetes on recipients by organ type, prevention and management will need to be tailored,” said co-author Alan L. Hutchison, MD, PhD, of UChicago Medicine, in a statement.