Inferior Long-Term Outcome of Renal Transplantation in Patients with Diabetes mellitus

Abstract

Objective: To retrospectively review the long-term outcome of renal transplant in diabetics at Mubarak Al-Kabeer Hospital and Hamad Al-Essa Organ Transplant Center, Kuwait from 1983 to 1998. Methods: There were 631 renal transplant patients, comprising 79 (12.5%) patients with pretransplant diabetes mellitus (pre-TDM), 117 (18.5%) patients with post-transplant diabetes mellitus and 435 (69%) nondiabetics (ND). Subjects with post-transplant diabetes mellitus were excluded from the comparative analysis. Distribution of sex, source of donors and mode of immunosuppression were similar in pre-TDM and ND groups. Results: Fifty-three (67%) recipients in pre-TDM and 90 (20.5%) in the ND group (p < 0.01) were above 45 years of age. However, 26 (33.3%) pre-TDM and 345 (79.5%) ND were below age 45. Among those who died, coronary artery disease led to death in 36% of pre-TDM and 27% in ND. Hyperlipidemia requiring drug therapy was observed in 37% pre-TDM and 6% ND. The incidence of severe infections was nearly twice in pre-TDM over ND recipients (1.9 vs. 1.0 per patient, p < 0.001). Acute rejection episodes were more frequently seen in pre-TDM (43%) than ND (33%), however the difference was not statistically significant. The patient survivals at 1, 5, 10, 14 years were significantly lower in pre-TDM (84, 65, 58 and 58%, respectively) than in ND (97, 93, 86 and 82%, respectively). The major contributory factors were severe infections and coronary artery disease. The cumulative graft survival showed a similar pattern (52% in pre-TDM, 73% in ND at 10 years). However, when death is excluded, the 10-year pure graft survival probability was similar for the pre-TDM and ND groups (76% vs. 80%). Conclusion: Our study indicates poor patient survival in pre-TDM due to coronary artery disease and infections, whereas the pure long-term graft survival was equally good in pre-TDM and ND transplant recipients.

Trends in the effects of pre‐transplant diabetes on mortality and cardiovascular events after kidney transplantation

“…However, previous comparisons of outcomes in kidney recipients with and without diabetes have yielded conflicting results. Several studies found that the survival rate was lower in kidney transplant recipients with diabetes than in those without diabetes, which was attributed to a high incidence of cardiovascular events [11][12][13][14] , whereas others found no significant differences in patient outcomes [15][16][17][18] . Furthermore, although two previous studies investigated temporal trends in kidney transplant outcomes in patients with and without diabetes, the findings were inconsistent 19,20 .…”

Is Age Associated with the Number or Types of Medications Prescribed to Renal Transplant Recipients?

“…Together, the findings regarding the greater likelihood of developing PTDM, greater number of antidiabetic medications, and higher fasting blood glucose measures suggest that elderly recipients may experience greater difficulty in controlling their diabetes mellitus than younger recipients. Because research indicates that pre‐ and posttransplant diabetes mellitus adversely affect patient survival, 31–33 elderly recipients' blood glucose levels and response to antidiabetic therapy should be closely monitored and treated appropriately to prevent adverse health outcomes.…”

Renal allograft nephropathy in patient with type 1 diabetes mellitus

“…При СД дислипидемия рассматривается как следствие основного заболевания, особенно в условиях неадекватного контроля гликемии и целого ряда сопутствующих факторов -возраста, избыточной массы тела и ожирения, поражения почек и т.д. При изучении параметров липидного спектра у пациентов после АТП, дислипидемия достоверно чаще наблюдалась у пациентов с СД -в 37% случаев, чем у пациентов без диабетатолько в 6% [14]. Коррекция нарушений липидного обмена сохраняет важное значение после АТП для профилактики прогрессирования гломерулосклероза.…”