Impact of donor diabetes mellitus status on liver transplant outcomes in patients with acute-on-chronic liver failure

Liver transplantation (LT) is the most effective way to save patients with acute-on-chronic liver failure (ACLF). However, the impact of donor diabetes mellitus (DM) on LT outcomes in patients with ACLF has not been fully investigated. We retrospectively analyzed data from the Scientific Registry of Transplant Recipients (SRTR) between January 1^st, 2008 to December 31^st, 2017 in this study. All the patients were divided into donors with DM and without DM group (DM: 1,394; non-DM: 11138). We compared the overall survival (OS) and graft survival (GS) across different estimated ACLF (estACLF) grades between two groups. There were 25.10% estACLF-3 patients in the entire cohort. And in estACLF-3 patients, 318 patients had DM donors. The estACLF-3 associated 5-year OS rate in the non-DM group was 74.6%, significantly better than that in the DM group, with corresponding survival rate at 64.9% (<i>P</i> &lt; 0.001). Donor DM was an independent predictor for OS in the entire cohort as well as in estACLF-3 patients. Donor DM was associated with inferior outcomes of LT in patients with estACLF-3. However, the differences were not obvious in recipients with other estACLF grades.