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Kidney transplantation with and without prior dialysis therapy in diabetic patients with end-stage renal failure
1Fourth Department of Medicine, Helsinki University Hospital, Finland.
Insights
Early kidney transplantation without dialysis may slow cardiovascular complications in diabetic patients. Survival and graft success rates were similar between non-dialyzed and dialyzed patients, suggesting dialysis is not essential pre-transplant.
Area of Science:
- Nephrology
- Cardiology
- Transplantation
Background:
- Cardiovascular disease is a leading cause of mortality in diabetic patients.
- Uremia accelerates cardiovascular morbidity, necessitating renal replacement therapy.
- Diabetic nephropathy is a common cause of end-stage renal failure.
Purpose of the Study:
- To evaluate the impact of pre-transplant dialysis on outcomes in diabetic kidney transplant recipients.
- To determine if early transplantation without dialysis affects cardiovascular complication progression.
- To assess graft survival and operative risks in diabetic patients undergoing kidney transplantation with or without prior dialysis.
Main Methods:
- Retrospective analysis of 125 diabetic patients who received kidney grafts between 1973-1982.
- Comparison of outcomes between 24 patients transplanted without prior dialysis and those who underwent dialysis.
- Assessment of patient survival, graft survival, cardiovascular complications, and surgery-related complications.
Main Results:
- One-year patient survival was higher in non-dialyzed patients (82%) versus dialyzed patients (65%).
- Seven-year patient survival (45% vs. 41%) and graft survival rates were similar between groups.
- Despite higher pre-transplant myocardial infarction rates in non-dialyzed patients, post-transplant cardiovascular mortality was not increased. Previous dialysis did not affect surgery-related complications.
Conclusions:
- Pre-transplant dialysis does not appear to influence long-term patient or graft survival in diabetic kidney transplant recipients.
- Early kidney transplantation without dialysis is a viable option for slowing cardiovascular complications in diabetic end-stage renal failure patients.
- The findings challenge the traditional contraindications for kidney transplantation without prior dialysis in this population.
Abstract:
Cardiovascular disease is the main cause of death in diabetic patients. Uraemia seems to increase progression of cardiovascular morbidity. Therefore early transplantation even without pretransplant dialysis could be a way of slowing progression of cardiovascular complications in patients with endstage renal failure due to diabetic nephropathy. The risk for impaired graft survival and operation-induced complications have been considered contraindications for kidney transplantation without previous dialysis. To examine whether dialysis before transplantation influences the outcome of diabetic patients after kidney transplantation data from 125 diabetic patients receiving a kidney graft during 1973-1982 was retrospectively analyzed. Twenty-four of them were transplanted without previous dialysis. One-year patient survival was somewhat higher in patients transplanted without previous dialysis than in dialyzed patients (82 and 65%) but similar 7 years after transplantation (45% and 41%). Graft survival was also similar in both groups. Although the nondialyzed patients had had more myocardial infarctions before transplantation, prevalence of mortality in cardiovascular complications after transplantation were not increased compared with dialyzed patients. Previous dialysis did not influence surgery-related complications.