BACKGROUND: Diabetes mellitus (DM) is associated with increased mortality following transplantation, but the effect of glycemic control on survival is unknown.We sought to determine the relationship between glycemic control (random (RBG) and fasting (FBG) blood glucose, HbA1c) and survival in all lung transplant (LTx) recipients and those with either persistent or no DM. METHODS: All 210 LTx recipients from 1 August 2010 - 1 November 2013 were included (median observation 3.0 years). All underwent oral glucose tolerance tests pre and serially post-LTx. All glucose and HbA1c results from LTx until study end were included and hazard ratios were calculated. RESULTS: Of 210 patients, 90 had persistent DM, and 84 had no DM. Overall mortality/repeat LTx was 31%. In the whole cohort, each 1 mM (18 mg/dl) increase in mean FBG and RBG and each 1% increase in mean HbA1c was associated with mortality increases of 18% (95%CI 5-32%, p=0.006), 38% (15-65%, p<0.001) and 46% (15-85%, p=0.002) respectively. RBG correlated with mortality in the persistent DM and no DM groups (37% (7-75%, p=0.012) and 109% (3-323%, p=0.041) increases/1 mM respectively). CONCLUSIONS: Glycemic control strongly correlates with survival following LTx. RBG predicted mortality overall and in patients with and without DM. We propose hyperglycemia be managed promptly after LTx.