New-Onset Diabetes After Liver Transplantation: An SRTR Database Study of Incidence and Risk Factors

BACKGROUND New-onset diabetes after transplantation (NODAT) is a common complication following liver transplantation, with serious patient and graft outcomes. The recent advances in transplant techniques and management have improved patient survival and consequently led to an increase in NODAT. Therefore, this study aimed to evaluate the current trends in the incidence, risk factors, and impact of NODAT on outcomes using a large national-level database. MATERIAL AND METHODS Adult liver transplant recipients who underwent the procedure between 2013 and 2022 were identified from the Scientific Registry of Transplant Recipients database. NODAT was defined as diabetes newly diagnosed after transplantation. Logistic regression was used to identify risk factors. Kaplan-Meier analysis and Cox regression analysis were performed to assess the impact of NODAT on patient and graft survival. RESULTS Among 39 828 recipients who met the study criteria, 2973 (7.5%) developed NODAT. Independent risk factors for NODAT included recipient age >50 years, male sex, BMI >25 kg/m², cytomegalovirus infection, steroid and tacrolimus use at discharge, deceased donor, longer warm ischemia time, and donor diabetes history. NODAT was associated with decreased graft survival (HR=1.28, 95% CI=1.10-1.48, P<0.001) but not patient survival. Moreover, the recipients who developed NODAT had higher rates of graft failure due to vascular thrombosis. CONCLUSIONS NODAT affects 7.5% of liver transplant recipients and is associated with decreased graft survival. Identifying high-risk patients and optimizing modifiable risk factors may help improve outcomes.