Improved Results of Cadaver Renal Transplantation in the Diabetic Patient

Abstract

The results of 54 renal transplants performed on 48 patients with end stage renal disease and insulin-dependent diabetes mellitus are reported. Pre-transplant screening with coronary angiography was done to determine the presence and severity of coronary artery disease and left ventricular dysfunction. There were 12 living related donor (group 1) and 42 cadaver renal transplants. The cadaver transplant recipients were grouped further into those who received additional prophylactic immunosuppression with antilymphoblast globulin (group 2, 18 patients) and those who received standard immunosuppression with azathioprine and prednisone (group 3, 18 patients). The 2-year patient and graft survival rates in groups 1 to 3 were 81 and 67, 88 and 69, and 61 and 32 per cent, respectively. The use of prophylactic antilymphoblast globulin for adjunctive immunosuppression resulted in significantly improved graft survival among cadaver recipients (p less than 0.003). Selection of patients for transplantation on the basis of preliminary screening with coronary angiography was found to have a major impact on patient survival.

End-Stage Renal Failure in Diabetic Nephropathy: Pathophysiology and Treatment

“…88, 89. 92, 94-99], These materials show that patient and graft survival rates have im proved during the years and in some materi als are close to those obtained in nondiabctic patients [96], It is also demonstrated that the best results are obtained in identical siblings or other HLA-identical related living donors with 80-90% graft survival at 1 and 2 years [88,96,97], Patient as well as graft survival were poorer when cadaveric grafts were used, patient survival varying between 42 and 68% and graft survival between 33 and 64% at 2 years [66, 88. 89.…”

“…93, 96, 97]. A great varia tion in patient survival (10-60%) at 5 years after cadaveric renal transplantation in insu lin-dependent diabetic patients might be ex plained to some extent by the heterogeneity of the materials [66,88,93,96,97], It ap pears that vascular heart disease is the most serious threat to a prolonged life after renal transplantation in diabetic patients, while re tinal changes arc less important [88,93,95,96]. In a series of 100 diabetic patients with ESRF.…”

“…Khauli ct al. [88,94] studied vascular disease performing coronary angiography be fore allocating patients to the transplantation program. They experienced significantly fewer deaths from heart failure than other series (3 in 48 patients) and these deaths occurred in cases with the most extensive degree of vascular heart disease.…”

“…The most severe angiographic changes were found in the 25 patients (25%) who were deliber ately allocated to dialysis treatment alone, because they were considered poor medical risk for transplantation. These studies left the question if some of the differences in graft and patient survival in the materials pub lished could be explained by the fact that the transplanted patients were selected from a larger group of patients on dialysis [66,88,95,99]. Vollmer et al [99] found that the presence of extrarenal diseases as diabetes and hypertension influenced patient survival on dialysis and after cadaveric transplanta tion equally.…”

Diabetic Nephropathy: Management of the end-stage patient

“…In a review of 48 diabetic patients who were screened by cardiac catheterization, 23 had coronary artery disease severe enough to warrant revascularization (75). These patients underwent coronary artery bypass without any mortality and were subsequently transplanted.…”