Data on the impact of pretransplant glycemic control on posttransplant cardiovascular (CV) outcome and survival is limited and inconsistent. We hypothesized that tighter glycemic control pretransplant is associated with fewer CV events and death in diabetic patients after kidney transplant (KTx). Methods: Univariate and multivariate logistic regression and Cox regression analyses using SAS. An Α=0.05 was considered statistically significant. Results: 326 diabetic KTx patients transplanted between 2000 and 2012 were classified as Type 1 (n=52), Type 2 (n=224) or non-specified (n=50) and assessed for the development of CV events, death, and graft failure at 1, 5, and 10 yr posttransplant. Demographics included 63% males, age 55.6±10.7 (mean±SD) yr, and BMI 29.0±5.4 kg/m². In univariate analysis, pretransplant HbA1c was significantly associated with occurrence of CV events at 5 and 10 yr follow-up, but not with death or graft loss. Specifically, these associations were seen when HbA1c >6.5%. After adjusting for age, gender, BMI, LDL cholesterol, systolic blood pressure, and smoking status, pretransplant HbA1c remained significantly associated with CV events at 5 and 10 yrs. This was consistent with survival analysis showing an increased risk of CV event incidence. Conclusions: Poor pretransplant glycemic control is associated with increased CV event risk in patients with diabetes. Tighter glycemic control prior to transplant may lead to improvement in CV health.

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