Outcomes of Kidney Transplants From Standard Criteria Donors With Diabetes: A Propensity Score-Matched Study

Few studies have evaluated the impact of using donors with diabetes, which often leads to higher rates of organ refusal by transplant centers, based on the concern that the disease may negatively impact graft quality and the recipient outcomes. Therefore, this study aimed to evaluate 5-year outcomes of kidney transplant recipients (KTRs) who received kidneys from donors with diabetes but who met the standard United Network for Organ Sharing (UNOS) criteria.

Observational and longitudinal cohort study.

KTRs who received kidneys from deceased donors meeting standard UNOS criteria between 2013 and 2017 at a large-scale Brazilian center of transplantation.

Presence of diabetes in the donor.

Five-year estimated glomerular filtration rate (eGFR, mL/min/1.73 m²) and graft survival.

Comparison of KTRs from donors with (DM+) and without (DM-) diabetes, involving the entire cohort and after a 1:2 propensity score-matched analysis. eGFR was compared using generalized estimated equation and graft survival by Fine and Gray subdistribution hazards models.

Of 3,059 KTRs, 1,931 (63.1%) met the standard UNOS criteria, 73 being DM+ (3.8%). Before matching, the 1- and 5-year eGFRs were 42.5 and 34.6 among DM+, whereas they were 50.8 and 44.8 among DM-, respectively, with a significant mean difference in all eGFR measures (-9.07; P = 0.001), but with no interaction between presence of diabetes and time (P = 0.54). All demographic disparities between groups were controlled by propensity score. After matching, the 1- and 5-year eGFRs were 42.5 and 34.6 among DM+, whereas they were 46.1 and 38.8 among DM-, respectively, with no mean difference in all eGFR measures (-3.65; P = 0.26) and also with no interaction between presence of diabetes and time (P = 0.91). The 5-year graft survival was 84.6% for KTRs of DM+ vs. 88.1% (subdistribution HR = 1.40; P = 0.25) before and 84.3% (subdistribution HR= 1.02; P = 0.96) after propensity score matching.

Retrospective and single-center study.

Five-year eGFR and graft survival were inferior among KTRs of donors with diabetes; however, when the key demographic disparities were controlled using propensity score matching, no impact was observed in long-term outcomes when donors with diabetes are used.