*Purpose: Diabetic patients undergoing heart transplantation may be at greater risk of developing kidney dysfunction after heart transplantation due to calcineurin inhibitor (CNI) nephrotoxicity. It is not known whether diabetes in patients who have normal kidney function at the time of transplant are at greater risk of developing kidney dysfunction after heart transplantation compared to non-diabetic patients. Furthermore, it is not known whether the addition of angiotensin-converting enzyme inhibitors (ACEi) can ameliorate the development of proteinuria in these diabetic patients compared to those without diabetes.

*Methods: Between 2010 and 2019, we assessed 34 heart transplant patients who had pre-transplant diabetes with normal kidney function (creatinine <1.3) at the time of transplant and were placed on an ACEi within 3 months of transplant for a minimum of 1 year. Comparison groups included pre-transplant non-diabetic patients on ACEi (n=66), pre-transplant diabetic patients not on ACEi (n=81), and pre-transplant non-diabetic patients not on ACEi (n=147). For all groups, renal function was measured by serum creatinine at 1 year post-transplant. 1-year freedom from proteinuria was also assessed.

*Results: Pre-transplant diabetic patients not on ACEi had the greatest rise in creatinine at 1 year compared to the other groups (see table). 1-year freedom from proteinuria was not significantly different among the study groups.

*Conclusions: The addition of ACEi in pre-transplant diabetic patients may be protective against CNI nephrotoxicity. Further studies will need to be done to confirm these findings.

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