Diabetes Increases Mortality Risk Across All Major Organ Transplants

The presence of diabetes substantially increases long-term mortality across all major organ transplants, with baseline and new-onset diabetes showing similar impact, according to new research.¹

These data were presented at the Endocrine Society (ENDO) Annual Meeting 2026 in Chicago, Illinois, by Mishal Ali, a graduate researcher at the University of Chicago, and Alan Hutchison, MD, PhD, a clinical instructor of medicine and transplant hepatologist at the University of Chicago Medicine.¹

“A key thing that came out of the data that I certainly wasn’t expecting was that even after that first year period, there’s still a high incidence of developing diabetes,” Hutchison told HCPLive in an exclusive interview. “We know that immunosuppression is very high at the beginning of the post-transplant experience and usually tapers off but still remains elevated. That risk also remains elevated, and so we can’t stop paying attention to that concern.”

Patients receiving solid organ transplants are typically prescribed immunosuppressive therapies to avoid autoimmune rejection of the organ by the body. These medications weaken the body’s immune system, thereby potentially limiting its capacity to fight off disease. To this end, patients receiving transplants are at an increased risk of diabetes, as well as infections such as hepatitis C.²

Ali and colleagues performed the present multi-organ analysis by examining 803,762 single-organ transplant recipients. Among these, 441,362 received kidney transplants, 264,461 received liver transplants, 75,777 received heart transplants, 42,174 received lung transplants, 6923 received pancreas transplants, and 2706 received intestine transplants. The team assessed baseline diabetes prevalence, new-onset diabetes (NODAT) incidence, and mortality, using Kaplan-Meier survival analysis and Cox proportional hazards regression to stratify patients by diabetes status.¹

Ali and colleagues found that baseline diabetes prevalence was substantially variable, present in 4.7% of intestine recipients, 16.8% of lung recipients, 22.3% of heart recipients, 24.4% of liver recipients, and 32.2% of kidney recipients. Among non-diabetic recipients, NODAT incidence over 6 months was 0.2% among both heart and lung recipients, 2.2% among intestine recipients, 2.6% among kidney recipients, and 2.8% among liver recipients.¹

By 1 year, NODAT rates were 2.5% for intestine recipients, 3.1% in kidney recipients, 3.6% in liver recipients, 5.8% in heart recipients, and 5.9% in lung recipients. The team also demonstrated significantly increased mortality risk with baseline diabetes through Cox regression. These equated to the following:

• Kidney: HR 1.86 (95% CI, 1.83-1.89; P <.001)
• Liver: HR 1.28 (95% CI, 1.26-1.31; P <.001)
• Heart: HR 1.29 (95% CI, 1.24-1.33; P <.001)
• Lung: HR 1.06 (95% CI, 1.02-1.1; P <.001)¹

Absolute survival differences between the diabetic and non-diabetic groups at 1 year were 2.2% among kidney recipients (98.2% vs 95.9%), 1.9% in liver recipients (94.6% vs 92.7%), 1.4% among heart recipients (95% vs 93.5%), and 0.1% among lung recipients (90.5% vs 90.3%). By 10 years, the team found that these differences widened significantly, with kidney recipients reaching 23.8% (81.3% vs 57.5%), liver recipients reaching 12.3% (69.9% vs 57.7%), heart recipients seeing 10.7% (66.1% vs 55.4%), and lung recipients reaching 0.3% (33# vs 32.7%). Developing NODAT also substantially increased subsequent mortality as follows:

• Kidney: HR 1.3 (95% CI, 1.24-1.37; P <.001)
• Liver: HR 1.26 (95% CI, 1.2-1.32; P <.001)
• Heart: HR 1.3 (95% CI, 1.23-1.36; P <.001)
• Lung: HR 1.11 (95% CI, 1.06-1.17; P <.001)¹

Ultimately, the team concluded that the 6.8-fold variation in diabetes burden highlights a need for organ-specific prevention and management strategies.¹

“There are certain factors that make a diagnosis in the post-transplant population genuinely difficult, and that includes cirrhosis, particularly in the liver,” Ali told HCPLive. “We need to think about it in a more organ-specific framework. A1c is becoming unreliable. Anemia, cirrhosis, and a few other conditions make it more unreliable to start assessing their baseline understanding of diabetes to begin with.”

Editors’ Note: Hutchison and Mishal have no relevant disclosures to report.

References

1. Mishal A, Hutchison A. Diabetes Burden and Mortality in Solid Organ Transplantation: A Comprehensive Multi-Organ Analysis. Abstract presented at the Endocrine Society (ENDO) Annual Meeting 2026, Chicago, IL. June 13-15, 2026

2. Chowdhury TA. Post-transplant diabetes mellitus. Clin Med (Lond). 2019;19(5):392-395. doi:10.7861/clinmed.2019-0195