Outcomes of kidney transplantation using deceased donors with history of diabetes

Abstract

Deceased diabetic kidneys are increasingly utilized in transplantation. The relationship of donor's history of diabetes to clinical and histological outcomes was examined. Forty‐nine diabetic deceased donor kidneys (D‐DM) were transplanted into 26 normal (R‐N/D‐DM) and 23 diabetic recipients (R‐DM/D‐DM) and compared to 211 diabetic recipients of normal kidneys(R‐DM/D‐N) and 466 normal recipients of normal kidneys (R‐N/D‐N). Patient survival at 5 years was 89.7% in R‐N/D‐N, 96.2% in R‐N/D‐DM, 80.1% in R‐DM/D‐N, and a 71.6% in R‐DM/D‐DM (P = .008). Death‐censored graft survival at 5 years was 86.3% in R‐N/D‐N, 87.4% in R‐N/D‐DM, 93.5% in R‐DM/D‐N, and 87.5% in R‐DM/D‐DM (P = .24). Multivariable regression analysis showed that compared to non‐diabetic recipients, diabetic recipients had a 2‐ to 3‐fold increased risk of mortality. In this cohort, there was no impact on death‐censored graft survival of diabetic donor status. Only 6 of 26 post‐perfusion biopsies showed evidence of diabetic nephropathy (<IIa), and on repeat biopsies 70% showed no evidence of progression. Survival of recipients of diabetic donor kidneys appears dependent on the diabetic status of the recipient with the worst survival being in diabetic recipients of a diabetic donor kidney. In this cohort, donor kidneys had paucity of structural diabetic lesions and most did not show progression.

Ongoing donor-transmitted diabetic kidney disease in kidney transplant recipients with fair sugar control: a single center retrospective study

“…Recently, Truong et al [ 14 ] and Khan et al [ 15 ] reported 26 diabetic donor kidney transplantations with post-perfusion biopsies and follow-up biopsies. All the donors in their study with dipstick proteinuria < 2+ (< 300 mg/g) showed diabetic lesions equal or lower than RPS IIa category on pre-implantation biopsy.…”

“…The urine dipstick proteinuria or urinary protein creatinine ratio (UPCR) test may be a good screening test before pre-implantation biopsy. Truong et al [ 14 ] and Khan et al [ 15 ] reported that all their study donors with dipstick proteinuria < 2+ (< 300 mg/g) showed diabetic lesions equal or lower than RPS IIa category on pre-implantation biopsy. In our study, two donors with 2+ dipstick proteinuria were transplanted into three recipients in the biopsy proven DKD group.…”

“…One graft failure, higher proteinuria amount, a more rapid decline in the eGFR, and ongoing DKD were noted in the biopsy-proven DKD group in our study. Previous studies showed that diabetic donor kidneys with early stage of DN (equal or lower than class IIa) may have little adverse effect on graft survival, and DN may progress slowly or may stabilize [ 14 , 15 ]. Our findings differ from those of this study, as DN progress with poorer renal outcomes noted in recipients with DT-DKD.…”

We listed patients and we should transplant them

“…Kidneys from donors with a normal creatinine on admission but an elevated creatinine at organ recovery (acute kidney injury) have graft survival comparable to kidneys from donors without poor function 11‐14 . Kidneys from donors with a history of diabetes can be used without compromising recipient outcomes 15‐17 …”

“…[11][12][13][14] Kidneys from donors with a history of diabetes can be used without compromising recipient outcomes. [15][16][17] The Kidney Donor Profile Index (KDPI) score also has limited usefulness. In 2013, 59 percent of kidneys with a KDPI > 85 were discarded 18).…”