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Kidney transplantation with preformed diabetic nephropathy kidney: review of pathological changes and clinical
Shujing Li1, Yang Wang2, Beike Chen1
1Department of Urinary Nephropathy Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Introduction:
Kidney transplantation from expanded-criteria donors represents an effective approach to alleviate organ shortages. The feasibility for transplantation of donor kidneys with preformed diabetic nephropathy (DN) has not been extensively investigated.
Search Strategy:
We performed a literature review to explore the pathological changes and clinical outcomes of kidney transplantation using preformed DN kidney. A systematic and comprehensive search was conducted from the inception to June 13, 2024.
Results:
Data from eight articles encompassing 103 cases were included for analysis. The pooled proportions of stable, progressive, and reversed DN-related pathological change were 0.66 (95% CI 0.56-0.77, I2 = 21.77%), 0.27 (95% CI 0.18-0.36, I2 = 10.04%) and 0.05 (95% CI 0.01-0.10, I2 = 0.00%), respectively. Eight-six cases were divided into post-transplant hyperglycemia group and normal post-transplant blood glucose group to evaluate the effect of post-transplant hyperglycemia on DN pathology, indicating the normal post-transplant blood glucose group had higher proportions of stable and reversed pathological states. Most cases achieved a graft survival rate of more than 80% at around five years post-transplant.
Conclusion:
A majority of transplantations use donor kidneys with preformed DN exhibit acceptable renal pathological changes and graft survival. However, post-transplant hyperglycemia may adversely affect the pathological progression of the kidneys, particularly in cases with long-term follow-up.
Insights
Kidney transplants using donor kidneys with diabetic nephropathy (DN) show good graft survival. However, managing post-transplant blood sugar is crucial to prevent DN progression and ensure long-term success.
Area of Science:
- Nephrology
- Transplantation immunology
- Diabetology
Background:
- Expanded-criteria donors are vital for addressing organ shortages in kidney transplantation.
- The use of donor kidneys with preformed diabetic nephropathy (DN) remains under-investigated.
Purpose of the Study:
- To evaluate the pathological changes and clinical outcomes of kidney transplantation utilizing donor kidneys with preformed DN.
- To assess the impact of post-transplant hyperglycemia on DN progression in kidney grafts.
Main Methods:
- A systematic literature review was conducted from inception to June 13, 2024.
- Data from eight articles involving 103 cases were analyzed.
- Pooled proportions of DN pathological changes and graft survival rates were calculated.
Main Results:
- Stable, progressive, and reversed DN pathological changes occurred in 66%, 27%, and 5% of cases, respectively.
- Kidneys transplanted into recipients with normal post-transplant blood glucose showed more stable or reversed DN pathology.
- Graft survival exceeded 80% at approximately five years post-transplant.
Conclusions:
- Kidney transplantation with preformed DN donor kidneys generally yields acceptable pathological changes and graft survival.
- Post-transplant hyperglycemia is associated with adverse pathological progression of DN in transplanted kidneys, especially long-term.
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