Key takeaways:
- In patients receiving an organ transplant, mortality risk was greater in those with diabetes vs. without.
- The risk was elevated regardless of whether diabetes diagnosis occurred before or after the transplant.
CHICAGO — In patients who received an organ transplant, diabetes — whether diagnosed before or after transplantation — was linked to elevated risk for mortality, researchers reported at ENDO 2026.
The researchers analyzed data from 803,762 U.S. patients who received a single organ transplant between 1987 and 2021 and were included in the United Network for Organ Sharing or Organ Procurement & Transplantation Network databases. Among the cohort, 441,362 had a kidney transplant, 264,461 had a liver transplant, 75,777 had a heart transplant, 42,174 had a lung transplant, 6,923 had a pancreas transplant and 2,706 had an intestine transplant.
Patients who underwent an organ transplant have a higher mortality risk if they had been diagnosed with diabetes at any time. Image: Adobe Stock
“As a transplant hepatologist, I frequently see patients who have diabetes and had complications from it, and after going through a life-saving surgery [for] a donated organ, to have their life threatened by diabetes is just a travesty,” Alan L. Hutchison, MD, PhD, transplant hepatologist and clinical instructor at UChicago Medicine, told Healio.
Alan L. Hutchison
At baseline, 4.7% of intestine transplant recipients, 16.8% of lung transplant recipients, 22.3% of heart transplant recipients, 24.4% of liver transplant recipients and 32.2% of kidney transplant recipients had diabetes, according to the researchers.
Among those without diabetes at baseline, new-onset diabetes developed at a rate of 0.2% at 6 months and 5.8% at 1 year in heart transplant recipients, 0.2% at 6 months and 5.9% at 1 year in lung transplant recipients, 2.2% at 6 months and 2.5% at 1 year in intestine transplant recipients, 2.6% at 6 months and 3.1% at 1 year in kidney transplant recipients and 2.8% at 6 months and 3.6% at 1 year in liver transplant recipients, the researchers found.
After adjustment for age and sex, patients with baseline diabetes had increased risk for mortality compared with patients without baseline diabetes (adjusted HR for kidney = 1.86; 95% CI, 1.83-1.89; aHR for heart = 1.29; 95% CI, 1.24-1.33; aHR for liver = 1.28; 95% CI, 1.26-1.31; aHR for lung = 1.06; 95% CI, 1.02-1.1; P for all < .001), according to the researchers.
Differences in absolute survival rates between patients with and without diabetes at 1 year ranged from 0.1 percentage points in lung transplant recipients to 2.2 percentage points in kidney transplant recipients, but at 10 years, the differences were 0.3 percentage points in lung transplant recipients, 10.7 percentage points in heart transplant recipients, 12.3 percentage points in liver transplant recipients and 23.8 percentage points in kidney transplant recipients, according to Hutchison and colleagues.
After adjustment for age and sex, patients with new-onset diabetes had increased risk for mortality (aHR for kidney = 1.12; 95% CI, 1.09-1.31; aHR for heart = 1.3; 95% CI, 1.23-1.36; aHR for liver = 1.13; 95% CI, 1.14-1.21; aHR for lung = 1.11; 95% CI, 1.06-1.17; P for all < .001), Hutchison and colleagues found.
“The main thing we suspect is going on is increased risk of infection, and then further out, increased cardiovascular risk,” Hutchison told Healio.
In the presentation, the researchers showed updated results after adjusting for transplant year and BMI, showing that most HRs stayed consistent or increased for mortality with the exception of patients who had a heart transplant who develop new-onset diabetes being at the highest risk for mortality compared with recipients of other organs.
Mishal Ali, a Master’s student at the University of Chicago who presented the findings, told Healio that “organ-specific screenings need to be put in place to help patients and clinicians better understand the risk for developing diabetes, and if they already have diabetes, what does their posttransplant journey look like?”
Clinicians tend to be focused on risk within 1 year after transplant, but for patients with baseline or new-onset diabetes, “the risks continue to accrue” for much longer, Hutchison told Healio.
Mishal Ali
“People who have organ failure and receive transplants have a unique physiology, which doesn’t necessarily match the physiology that we use in all the studies that we do in diabetes, so paying attention to what these individuals have in common across organ types in posttransplant physiology, as well as how the end-organ failure impacts the ability to detect and manage diabetes, is something that needs attention and funding and publications so we can help these patients,” Hutchison said.
For more information:
Mishal Ali can be reached at mishalali00@uchicago.edu.
Alan L. Hutchison, MD, PhD, can be reached at alanlhutchison@uchicago.edu.
Sources/Disclosures
Source:
Ali M, et al. ORF06-03. Presented at: ENDO annual meeting; June 13-16, 2026; Chicago.
Disclosures:
Ali reports being an employee of Eli Lilly. Hutchison reports receiving institutional research funding from Madrigal.
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