Pre- and post-transplant diabetes and the risk of infection and mortality after heart transplantation in the USA

Reliable data regarding the association of diabetes mellitus (DM) after heart transplantation (HTx) and infections are lacking. We aimed to assess the association between pre- and post-HTx DM and hospitalizations for infections, mortality, and other secondary outcomes. Adult HTx recipients from the US Scientific Registry of Transplant Recipients transplanted between 1995 and 2021 without previous or multi-organ transplants were included. Uni- and multivariable Cox proportional hazard models were used to assess the association of pre-transplant DM (at HTx) and post-transplant DM compared to no DM with the rate of hospitalizations for infections and all-cause mortality and other secondary outcomes. A total of 53,219 patients were included, of whom 12,708 (23.9%) had DM at transplantation. Compared to non-diabetic participants, participants with pre-transplant DM were older, more likely to be male and less likely to be of white race. Both, pre- and post-transplant DM was associated with higher rates of hospitalization for infections (hazard ratio [95% confidence interval]: pre-HTx DM: 1.22 [1.18-1.27], post-HTx DM: 1.24 [1.16-1.32] and mortality (1.21 [1.17-1.25] and 1.3 [1.25-1.35], respectively). Both were also associated with higher rates of fatal infections and graft failure. Pre- and post-transplant DM are associated with higher rates of hospitalizations for infection and mortality after HTx.