Outcomes After Kidney Transplantation From Deceased Donors With Diabetes

Diabetes mellitus (DM) is an increasing comorbidity in the kidney donor population, but there are limited data on allograft outcomes from donors with DM. We investigated outcomes after kidney transplantation from deceased diabetic donors.

We undertook a retrospective observational study of adult patients who underwent kidney alone transplantation from deceased donors at a single center between 2012 and 2022 in the United Kingdom. We stratified transplants according to the diabetic status of both the donor and recipient. We compared clinical characteristics of diabetic donors and recipients, and determined patient and allograft survival at 1-, 3- and 5-years.

A total of 985 kidney transplant recipients (median age 54 years, 64% male, 25% diabetic) were included, and 64 (6.5%) underwent transplantation from a diabetic donor. Diabetic donors were older and had more hypertension, as well as higher kidney donor risk and implant Karpinski scores. Recipients of diabetic donor kidneys were also older and had higher baseline clinical frailty scores. Patient and allograft survival were worst in diabetic recipients of diabetic kidneys; outcomes were similar in non-diabetic recipients regardless of the diabetic status of the donor. In multivariable analyses, recipient age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03-1.08) and recipient diabetes (HR: 2.22, 95% CI: 1.32-3.67) increased the hazard of patient mortality but not death censored graft loss. Donor diabetes had no effect on any recipient outcomes.

Utilizing kidneys from diabetic donors is associated with acceptable recipient outcomes and offers a potential mechanism to expand the deceased donor pool. Recipient diabetes status should be considered during organ allocation.