Editor's Note: At the recently concluded American Diabetes Association (ADA) Annual Meeting, an oral presentation highlighted that liver transplant patients with type 2 diabetes (T2DM) have significantly higher postoperative mortality rates compared to those without diabetes. This finding holds substantial importance for improving liver transplant success rates and enhancing long-term survival outcomes for patients.

This study included adult liver transplant patients registered in the Scientific Registry of Transplant Recipients (SRTR) in the United States between 2007 and 2022. The primary objective was to evaluate the impact of pre-transplant T2DM on postoperative survival rates.

According to the study, 104,399 liver transplant patients were included, with an average age of 56±11 years, and 66% of them were male. The reasons for liver transplantation were chronic hepatitis C (25%), metabolic-associated steatohepatitis (MASH, 20%), alcoholic liver disease (31%), hepatocellular carcinoma (22%), and chronic hepatitis B (3%). Among all transplant recipients, 26% had T2DM before the transplant.

With an average follow-up time of 59 months, the results showed that patients with pre-transplant T2DM had cumulative mortality rates of 10%, 26%, and 45% at 1, 5, and 10 years post-transplant, respectively, significantly higher than the 8%, 21%, and 37% observed in non-diabetic patients (all P-values <0.0001).

Multivariate survival analysis revealed that pre-transplant T2DM was independently associated with higher post-transplant mortality [aHR=1.28 (1.24-1.32)]. Other risk factors contributing to increased post-transplant mortality included older age, male gender, Black ethnicity, pre-transplant life support, and re-transplantation (P<0.01).

In addition to higher mortality rates, the study also found that patients with pre-transplant T2DM faced increased risks of postoperative complications, infections, and rejection. These findings underscore the critical importance of actively controlling and managing T2DM for patients preparing for liver transplantation.

This study offers new insights into the prognosis of liver transplant patients and provides crucial guidance for future liver transplant procedures. By strengthening the assessment and management of T2DM in patients before transplantation, it may be possible to reduce postoperative mortality and complication rates, improve surgical success rates, and enhance long-term survival outcomes. Additionally, this research serves as a reminder for diabetes patients to actively control and manage their condition to prevent further health complications.