Primary and Secondary Renal Transplantation in Diabetic Patients

Okiye, Stephen E.

doi:10.1001/jama.1983.03330280038026

Cited by 18 publications

(5 citation statements)

References 8 publications

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“…Our initial results of retransplantation in diabetics were poor, probably mainly due to insufficient dialysis and inadequate timing of the retransplantations. A negative attitude towards retransplantation in diabetics was recently expressed from the Mayo Clinic (16) but this is in contrast to our present opinion based on the very satisfactory outcome of retransplantation in patients belonging to era 11. Ten (83 %) of these 12 regrafted patients are currently alive.…”

Section: Graft Survival and Origincontrasting

confidence: 99%

“…When our results are compared with those of other leading centres (15-181, it is evident that there are no major differences in either patient or graft survival but since only three HLA-identical siblings were included among our donors, our LRD results should be compared with the results in the HLA-non-identical groups of the other centres (15,16). It is natural that both patient and graft survival tended to improve during era I1 compared to era I, and our transfusion policy may also have had an impact on the overall results (12).…”

Section: Graft Survival and Originmentioning

confidence: 99%

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Survival in End‐stage Diabetic Renal Disease

Larsson

Attman

Aurell

et al. 1984

Journal of Internal Medicine

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The results of renal transplantation in patients with diabetes mellitus were studied in 100 consecutive patients transplanted between Dec. 1972 and June 1982. The study period was divided into two parts, 1972–76 (era I, 21 patients, 18 with juvenile onset diabetes) and 1977–82 (era II, 79 patients, 72 with juvenile onset diabetes). A group of 168 non‐diabetic patients, aged 20–54 years, receiving primary grafts during the same period served as controls to the 72 juvenile onset diabetics from era II. The three‐year actuarial patient survival of transplanted diabetics improved from 48 % during era I to 76 % during era II and was then not significantly inferior to that of the non‐diabetic controls. The three‐year actuarial graft survival rate was significantly higher for recipients of kidneys from living related donors than for those who had received kidneys from cadaveric donors (CD) among both diabetic and non‐diabetic patients. However, the three‐year graft survival rate was significantly higher (56%) for non‐diabetic than diabetic CD recipients (37%). The overall survival in diabetes mellitus was strongly influenced by the outcome of retransplantation during era II (12 patients). Thus, 69 patients were alive, 64 with a functioning graft, at the end of the observation period.

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Section: Graft Survival and Origincontrasting

confidence: 99%

Section: Graft Survival and Originmentioning

confidence: 99%

Survival in End‐stage Diabetic Renal Disease

Larsson

Attman

Aurell

et al. 1984

Journal of Internal Medicine

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“…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.…”

Section: Results From Renal Transplantation In Insulin-dependent Diabmentioning

confidence: 83%

“…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.…”

Section: Results From Renal Transplantation In Insulin-dependent Diabmentioning

confidence: 99%

“…Myocardial infarction occurs with higher fre quency than in nondiabctic transplants (11 vs. 2%) [96]. Also the retinal changes pro gress in many patients, but significantly slower than during HD [97], Recurrence of diabetic nephropathy is recognized in graft biopsies and present in the majority of pa tients a few years after renal transplantation [96,102], The progression in the diabetic renal disease is slow and a very rare cause of graft failure compared to chronic allograft reaction [92],…”

Section: Long-term Complications In Diabetic Renal Transplantsmentioning

confidence: 99%

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

Schmitz¹,

Hansen²,

Ørskov³

et al. 1985

Blood Purif

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Forty percent of patients with insulin-dependent diabetes will develop nephropathy during the course of their disease, thus being the most important single disorder leading to end-stage renal failure (ESRF). Intensive metabolic control delays onset of diabetic nephropathy, the first omen of which is appearance of subclinical albuminuria, also termed microalbuminuria. Moreover, it is now established that intensive treatment of hypertension reduces rate of decline in GFR and thus postpones ESRF.When uremia eventually sets in, a range of biochemical and endocrine abnormalities can be included among those characteristics of diabetes mellitus per se. These include elevated plas ma levels of growth hormone, glucagon and free fatty acids, which may participate in the uremic insulin resistance superimposed on the preexisting diabetic carbohydrate intolerance.Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are two established modalities of renal replacement therapy in diabetes mellitus. Controlled clinical trials for comparison of CAPD versus HD treatment of diabetics are, however, still needed. The survival rate is approximately 80 and 65-95 % in insulin-dependent diabetic patients at 1 year during treatment with HD and CAPD, respectively. However, it is general experience that diabetics on CAPD exhibit a glycemic control, superior to that attained during HD. It has not been proved that patient survival after cadaveric renal transplantation is better than on dialysis. The degree of vascular heart disease seems to be the major determinant for survival of kidney-transplanted diabetic patients.

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Renal Transplantation in Systemic Inherited and Metabolic Disease

Lederer¹,

Suki²

1991

Therapy of Renal Diseases and Related Disorders

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Primary and Secondary Renal Transplantation in Diabetic Patients

Cited by 18 publications

References 8 publications

Survival in End‐stage Diabetic Renal Disease

Survival in End‐stage Diabetic Renal Disease

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

Renal Transplantation in Systemic Inherited and Metabolic Disease

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