Abstract: SA-PO1058
Effect of Different Hemoglobin A1c Targets on Cardiovascular Outcomes in Kidney Transplant Recipients with Diabetes: A Global Cohort Analysis
Session Information
- Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Bobba, Sindhura, Richmond VA Medical Center, Richmond, Virginia, United States
- Gupta, Gaurav, Virginia Commonwealth University, Richmond, Virginia, United States
- Kumar, Dhiren, Virginia Commonwealth University, Richmond, Virginia, United States
- Paulus, Amber B., Virginia Commonwealth University, Richmond, Virginia, United States
- Athreya, Akshay, Virginia Commonwealth University, Richmond, Virginia, United States
- Patel, Nilang G., Richmond VA Medical Center, Richmond, Virginia, United States
Background
The American Society of Transplant suggests targeting HbA1c around 7.0-7.5% and avoiding HbA1c ≤6.0% based on general population data. However, a specific HbA1c target to reduce cardiovascular morbidity and mortality in kidney transplant(KT)recipients is lacking. This study aims to investigate the relationship between various post-KT HbA1c targets and cardiovascular outcomes.
Methods
A retrospective cohort analysis of TriNetX Global collaborative network of adults with Type2DM who received KT(excluding pancreas transplants) from 2010 to 2021. HbA1c levels were collected 1 to 2 years post-KT and categorized into different groups based on target of ≤8.5, ≤ 8, ≤7.5, ≤7, and ≤6.5. To address confounding variables, 1:1 propensity score matching (PSM) was performed using 42 variables. The primary outcome was major adverse cardiac events (MACE)—comprising acute MI, heart failure, stroke, cardiac arrest, or death—while mortality was the secondary outcome. Adjusted hazard ratios(aHRs) with 95% confidence intervals(CIs) and P-values were calculated using Cox regression models.
Results
12,792 adults[age 57(+11.3) yrs, male(63.6%), white(44.7%)] were in final cohort and 7266(56.8%) had A1c value from 1 to 2 years post-KT. Out of them, 5196 (71.5%) had A1c <=8.5, 4758(65.5%) had A1c < =8, 4167(57.4%) had A1c <=7.5, 3350(46.1%) had A1c <=7 and 2451(33.7%) had A1c < =6.5. After PSM, MACE events were lower in patients with lower HbA1c levels across all thresholds: HbA1c ≤8.5 vs. >8.5 (aHR 0.83,95% CI:0.71-0.96), HbA1c ≤8 vs. >8 (aHR 0.83,95% CI:0.73-0.94), HbA1c ≤7.5 vs.>7.5 (aHR 0.88,95% CI:0.78-0.98), HbA1c ≤7 vs. >7 (aHR 0.94,95% CI:0.84-1.05), and HbA1c ≤6.5 vs.>6.5(aHR 0.98, 95% CI:0.86-1.12). (Table1, Figure1). Mortality rates were consistently lower in patients with lower HbA1c target threshold, however benefit disappear with A1c goal of ≤6.5 vs.>6.5 (Table1,Figure2).
Conclusion
HbA1c target of ≤7.5 associated with reduced MACE with reduction in mortality remains significant up to an HbA1c threshold of 7 in patients with Type 2 DM and KT