Transplantation of the kidneys in diabetics

Diabetic nephropathy affects half the type 1 diabetics and is the most frequent cause of death there. While in some countries diabetics account for 25-30% of all patients newly admitted in dialysis and transplantation programmes, in Czechoslovakia the number of diabetics treated by dialysis or transplantation is small. From August 1985 to June 1988, 15 isolated kidney transplant operations were performed on 13 diabetics with serious late complications of diabetes. By the time of writing, all recipients had been surviving (for 1 up to 35 months), and only two were receiving artificial kidney treatment. Progressive vascular complications were in two cases the cause of gangrene of the lower extremity, one patient had a central cerebrovascular attack. Despite this, successful transplantation resulted in a marked improvement of the patients' general condition and quality of life. Due to intensified insulin therapy, diabetes, too, was satisfactorily compensated in the majority of the recipients. As experience so far indicates, if the patient is prepared in good time, which includes diabetological, nephrological and ophthalmological treatment, the results of transplantation in diabetics can be comparable to those achieved in non-diabetic patients. Renal transplantation in diabetics should be developed in all transplantation centres in Czechoslovakia, and uraemic diabetics should not be eliminated from the dialysis-transplantation programme except in cases of serious contraindication.