Contribution of New-Onset Diabetes after Organ Transplantation on the Incident Cardiovascular Disease and Malignancy in Korea-A Nationwide Population-Based Study

Background: In Korea, the number of solid organ transplantation (TPL) has been markedly increased; however, there has been limited data on the adverse effect on the cardiovascular disease and malignancy of new onset diabetes after transplantation (NODAT) in solid organ TPL other than kidney. Methods: Using the National Health Insurance Service (NHIS) database which covers the claims of 97.0% of the population in Korea, the recipients of kidney, liver, and heart TPL in 2009-2015 were identified and categorized into 3 groups: without NODAT (reference), with NODAT, and pre-existing diabetes mellitus (DM). The incidence of myocardial infarction (MI), stroke, and malignancy till December 2018 in each group were compared using Cox-regression analysis. Results: Among the entire 18,763 cases of TPL identified, NODAT was detected in 29.8% (27.2% [2,903 out of 10,687], 43.4% [3,247 out of 7,747], and 41.5% [250 out of 602] in kidney, liver, and heart TPL, respectively); and 77.3% of NODAT cases were detected within 3 months after TPL. NODAT increased the risk of MI, but not of stoke, by 2.3 times compared to the reference group after adjustment for age, sex, hypertension, dyslipidemia, and immunosuppressants (hazard ratio [HR], 2.34; 95% CI, 1.61-3.51), which was observed only in kidney TPL (HR, 2.44; 95% CI, 1.52-3.91) but not in liver TPL. A significant increment of the risk of malignancy by NODAT was found only in kidney TPL (HR, 1.30; 95% CI, 1.04-1.64), whose statistical significance was lost after adjusting confounders. During the same period, no association between pre-existing DM and malignancy was found, neither. Conclusion: NODAT independently increased the risk of MI after organ transplantation, which was more evident in the recipient of kidney TPL. There was no additional increased risk of stroke or malignancy by NODAT in solid-organ TPL. Disclosure B.Koo: None. M.Moon: None. S.Park: None. K.Han: None.