Diabetes leads to negative mortality outcomes in kidney transplant patients

Kidney transplant recipients with diabetes tend to have almost twice as high mortality rates compared with patients without diabetes, although both groups had a severe impact on mortality during the COVID pandemic, according to a large population analysis reported at ERA 2025.

Dr Laia Oliveras (Hospital Universitari de Bellvitge, Spain) presented an analysis based on the European Renal Association Registry, including all patients who received a first kidney transplant between 2005 and 2022 in 12 European countries [1]. The maximum follow-up for each patient was 5 years, and diabetes was defined based on its classification as the primary cause of kidney failure. Mortality rates were standardised based on sex and age distributions to a normal population, and standardised mortality rate ratios (MRR) were used to compare the populations with and without diabetes.

A total of 134,231 individuals received a kidney transplant between 2005 and 2022, including 20,753 with diabetes. Overall, all-cause mortality rates tended to be stable between 2010 and 2019 and increased thereafter, both in patients with and without diabetes. The all-cause MRR between the two groups was 1.8. Similar trends were seen in cardiovascular mortality over time (MRR 2.3). A large component of all-cause mortality was driven by infection mortality, which markedly increased in both subgroups in the 2020-2022 period (overall infection-related MRR 1.6). Finally, cancer-related mortality remained stable over time, regardless of period, and the mortality was similar among the two subgroups (MRR 1.0).

“Kidney transplant recipients with diabetes had nearly two times higher mortality rates than those without diabetes, mainly due to cardiovascular and infection-related mortality”, concluded Dr Oliveras. However, “mortality rates for kidney transplant recipients remained stable from 2010 to 2019. During the COVID pandemic, both groups experienced an increase in infection-related mortality, when infection was the main cause of death.”

1. Oliveras L, et al. Trends in all-cause and cause-specific mortality in adult first kidney transplant recipients with and without diabetes as cause of kidney failure: an ERA Registry study. 62nd ERA Congress, 4–7 June 2025, Vienna, Austria.

Posted on 22 August 2025