Outcomes in liver transplant recipients with and without diabetes: A propensity-matched analysis using the TriNetX database.

e23094 Background: Diabetes mellitus (DM) is a common comorbidity among liver transplant recipients and has been associated with adverse post-transplant outcomes. This study aims to underscore the impact of DM on liver transplant recipients using a large real-world dataset, with propensity score matching to minimize confounding factors and provide a robust comparison of clinical outcomes. Methods: This retrospective cohort study analyzed data from the TriNetX database to compare outcomes between liver transplant recipients with and without diabetes. Propensity score matching was employed to account for baseline differences in demographics and comorbidities, such as age, race, and gender. This approach ensured that both groups were comparable, enabling a more accurate assessment of DM's impact on post-transplant outcomes. Results: After 1:1 propensity score matching, a total of 23545 patients were identified with Liver Transplant without DM and 23552 patients with DM. Before matching, significant differences existed between the two groups. Patients with DM were older (64.7 years vs. 54.6 years, p < 0.001) and had a higher prevalence of comorbidities such as hypertensive diseases (56.5% vs. 20.2%, p < 0.001) and ischemic heart diseases (24.4% vs. 6.4%, p < 0.001). The non-DM group included more females (40.8% vs. 34.9%, p < 0.001). After propensity matching, these differences were minimized: mean ages were 64.3 (non-DM) and 63.2 years (DM, p < 0.001), and gender distribution was balanced at ~36% female (p = 0.137). Post-matching, DM was associated with significantly increased odds of adverse outcomes. Liver rejection was more likely in DM patients (OR 1.489, CI 1.418–1.564, p < 0.001), as were liver failure (OR 1.425, CI 1.348–1.508, p < 0.001) and liver infection (OR 1.840, CI 1.605–2.109, p < 0.001). The risk of death was also elevated (OR 1.106, CI 1.053–1.162, p < 0.001). Additionally, DM patients faced greater odds of heart failure (OR 1.802, CI 1.698–1.911, p < 0.001) and acute kidney injury (OR 1.645, CI 1.582–1.709, p < 0.001). Conclusions: This analysis highlights the substantial impact of DM on liver transplant outcomes, with increased risks of rejection, failure, infection, and other complications. Propensity score matching confirmed these associations while controlling for baseline differences. These findings emphasize the critical need for heightened vigilance in this vulnerable population, and tailored post-transplant management and monitoring strategies for DM recipients. Condition Odds Ratio CI Lower Bound CI Upper Bound p-value Liver transplant rejection 1.489 1.418 1.564 <0.001 Liver transplant failure 1.425 1.348 1.508 <0.001 Liver transplant Infection 1.840 1.605 2.109 <0.001 Death 1.106 1.053 1.162 <0.001 Heart Failure 1.802 1.698 1.911 <0.001 Acute Kidney Injury 1.645 1.582 1.709 <0.001