ORF06-03 - Diabetes Burden and Mortality in Solid Organ Transplantation: A Comprehensive Multi-Organ Analysis

Background: Diabetes prevalence and mortality impact vary widely across organ transplant types, yet systematic cross-organ comparisons are lacking. We performed a comprehensive multi-organ analysis to characterize diabetes epidemiology and survival outcomes in solid organ transplant recipients.

Methods: We analyzed 803,762 single-organ transplant recipients from OPTN/UNOS (2003-2021): kidney (n=441,362), liver (n=264,461), heart (n=75,777), lung (n=42,174), pancreas (n=6,923), and intestine (n=2,706). We assessed baseline diabetes prevalence, new-onset diabetes (NODAT) incidence, and mortality stratified by diabetes status using Kaplan-Meier survival analysis and Cox proportional hazards regression adjusting for age and sex.

Results: Baseline diabetes prevalence varied 6.8-fold: intestine 4.7%, lung 16.8%, heart 22.3%, liver 24.4%, kidney 32.2%. Among non-diabetic recipients, 6-month NODAT incidence was heart 0.2%, lung 0.2%, intestine 2.2%, kidney 2.6%, and liver 2.8%. By 1 year, NODAT rates increased to intestine 2.5%, kidney 3.1%, liver 3.6%, heart 5.8%, and lung 5.9%. Cox regression demonstrated significantly increased mortality risk with baseline diabetes: kidney HR=1.86 (95% CI: 1.83-1.89), liver HR=1.28 (1.26-1.31), heart HR=1.29 (1.24-1.33), lung HR=1.06 (1.02-1.10), all p< 0.001. Absolute survival differences between diabetic and non-diabetic groups at 1 year were kidney 2.2% (98.2% vs 95.9%), liver 1.9% (94.6% vs 92.7%), heart 1.4% (95.0% vs 93.5%), and lung 0.1% (90.5% vs 90.3%). By 10 years, these differences widened substantially: kidney 23.8% (81.3% vs 57.5%), liver 12.3% (69.9% vs 57.7%), heart 10.7% (66.1% vs 55.4%), and lung 0.3% (33.0% vs 32.7%). Developing NODAT significantly increased subsequent mortality: kidney HR=1.30 (1.24-1.37), liver HR=1.26 (1.20-1.32), heart HR=1.30 (1.23-1.36), lung HR=1.11 (1.06-1.17), all p< 0.001.

Conclusions: Diabetes substantially increases long-term mortality across all major organ transplants, with both baseline and new-onset diabetes showing comparable impact. The 6.8-fold variation in diabetes burden emphasizes the need for organ-specific prevention and management strategies.