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Diabetic kidneys can safely expand the donor pool
Yolanda T Becker1, Glen E Leverson, Anthony M D'Alessandro
1Division of Transplantation, Department of Surgery, University of Wisconsin, Madison 53792, USA. yolanda@tx.surgery.wisc.edu
Background:
The demand for organs has increased exponentially with a new name added to the United States waiting list every 16 min. As such, kidneys from medically marginal donors are being considered for transplantation more frequently, including kidneys from individuals already at risk for renal disease, e.g., diabetic donors.
Methods:
We compared outcomes when using kidneys from donors with type 1 diabetes mellitus (D1) or type 2 diabetes mellitus (D2) at our center as a function of time. All patients with available data who underwent renal transplantation were evaluated (n=2013).
Results:
Forty-two individuals were recipients of D1 or D2 donor kidneys. Thirty of these individuals did not have diabetes (R0). All patients received quadruple sequential immunosuppression with cyclosporine (CsA) or tacrolimus (FK506). Donor serum creatinine (Scr) values were not significantly different. D2 kidneys came from older donors (mean age, 56+/-10.4 years; P< or =0.01 vs. D1 and D0 donors). Mean discharge Scr was greater in nondiabetic D2 recipients (D2/R0, 2.45+/-1.3 mg/dl; P=0.0016 vs. D0/R0), and transplantation of D1 or D2 kidneys was associated with a significantly increased frequency of posttransplant proteinuria (P=0.0089). Interestingly, R0 recipients of D1 or D2 kidneys were more likely to initiate oral hypoglycemic therapy after transplant (P=0.04). However, rejection episodes were not significantly different among groups, and long-term graft survival and patient survival were similar among groups.
Conclusions:
These data suggest that diabetic kidneys can be safely used without risk to patient or graft survival. Preexisting diabetic injury in the donor may increase the risk for proteinuria, compromised renal function, and posttransplant glucose intolerance.
Insights
Kidneys from donors with diabetes mellitus (type 1 or type 2) can be safely transplanted, showing similar long-term survival rates. However, recipients may face increased risks of proteinuria and post-transplant glucose intolerance.
Area of Science:
- Nephrology
- Transplantation Immunology
- Diabetology
Background:
- Increasing organ demand necessitates using kidneys from medically marginal donors, including those with diabetes.
- Diabetic donor kidneys are being considered more frequently for renal transplantation.
Purpose of the Study:
- To compare transplant outcomes using kidneys from donors with type 1 diabetes mellitus (D1) or type 2 diabetes mellitus (D2).
- To evaluate the safety and efficacy of diabetic donor kidney transplantation.
Main Methods:
- Retrospective analysis of 2013 renal transplant recipients.
- Comparison of outcomes between recipients of D1, D2, and non-diabetic donor (D0) kidneys.
- Assessment of graft function, proteinuria, rejection episodes, and patient/graft survival.
Main Results:
- Kidneys from donors with type 2 diabetes mellitus (D2) originated from older donors.
- Recipients of D2 kidneys showed higher mean discharge serum creatinine and increased post-transplant proteinuria.
- While not statistically significant, recipients of diabetic kidneys were more likely to require oral hypoglycemic therapy post-transplant.
- No significant differences in rejection episodes, long-term graft survival, or patient survival were observed among groups.
Conclusions:
- Diabetic donor kidneys can be safely utilized for transplantation without compromising patient or graft survival.
- Pre-existing diabetic nephropathy in donors may elevate risks for proteinuria, impaired renal function, and post-transplant glucose intolerance in recipients.