People with an organ transplant who develop or have existing diabetes are more likely to die than those without diabetes, according to a comprehensive analysis of solid-organ transplant recipients presented on June 14 at ENDO 2026, the Endocrine Society's annual meeting in Chicago, Illinois.
Diabetes is a common chronic disease affecting about 830 million people worldwide. Organ transplant recipients have a higher risk of developing and worsening diabetes, which can affect both their lifespan and the success of the transplant.
The researchers examined more than 800,000 Americans who received a kidney, liver, heart, lung, pancreas, or intestine transplant between 2003 and 2021. They compared two groups: people who already had diabetes when they received their new organ and people who developed diabetes for the first time after surgery.
They found both groups were more likely to die than recipients without diabetes. For people receiving a new liver or heart, newly developed diabetes was about as dangerous as having had diabetes for years. For kidney recipients, it was still dangerous but somewhat less so than having pre-existing diabetes. The association between diagnosis of diabetes and type of organ failure varied almost seven-fold based on organ type.
In the group that already had diabetes before transplantation, kidney recipients had the highest risk by far. Heart and liver recipients experienced a smaller increase in risk compared to kidney transplants. Lung recipients saw the smallest increase in risk. The difference in mortality rates was small at one year—around one to two more deaths per 100 patients for kidney, liver, and heart transplants—and almost no difference for lung transplants. This gap widened over time; ten years after transplantation nearly 24 more out of every 100 kidney recipients with diabetes had died.
Among those who developed diabetes after surgery, kidney and heart recipients faced the highest increased risk of death; liver recipient risks were slightly lower while lung recipient risks remained smallest.
"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 senior author and transplant hepatologist Alan L. Hutchison, M.D., Ph.D., of UChicago Medicine in Chicago. "Patients and their families can ask transplant providers more specific questions about diabetes risk, both before surgery and in the months after, and decide together whether extra check-ups or treatment make sense."
