Type 2 diabetic patients with nephropathy in a Scandinavian kidney-transplant population

Twenty-seven patients in a cohort of 1000 who received kidney transplants in Göteborg 1985-1993 were found to have diabetes of Type 2 as primary cause of renal failure. All took insulin at the time of transplantation. Four received concomitant pancreas transplants. Mean age was 53 years (range 40-64). All but four were men. Average waiting time on dialysis was less than a year. One year after transplantation 24 of 27 (89%) were alive, 22 (81%) with functioning grafts. However, during follow-up for a total of 51 +/- 27 months 9 (33%) of the diabetic patients died, mainly of cardiac disease or sudden death (n = 7), compared with 17% of matched controls (NS). Diabetic patients had an increased risk of death with a functioning graft, 6/27 versus 3/54 controls (p = 0.02). Graft survival rates were 56% and 65%, respectively (NS). Morbidity was dominated by cardiovascular events and foot ulcers leading to amputations (six patients) and septicaemia. During follow-up body mass index increased from 24.6 +/- 3.0 to 25.9 +/- 3.4 kg/m2. There was no difference in HbA1c-values although one pancreas-transplanted patient remained insulin-independent. The mortality and morbidity rates in this positive selection from a much larger population of Type 2 diabetic patients supports continued restriction in the acceptance rate for transplantation. Type 2 diabetes is not an indication for pancreas transplantation, which is one reason to distinguish this form of diabetes.