Renal Transplantation in Patients With Insulin-Dependent Diabetes Mellitus

Diabetic Nephropathy: Natural Course, Survivorship and Therapy

“…Transplantation with HLA-nonidentical living related donor or cadaver grafts is less suc cessful than in nondiabetics but appears to be roughly the equivalent of hemodialysis in terms of patient survival (tables V, A; X). In addition, in the Mayo Clinic experi ence [72], pretreatment of the cadaver graft donor with immunosuppressive agents improved patient survival at 1 year from 45% in nonpretreated cases to 78% with pre treatment.…”

“…However, the mean follow-up time was only 11 months. In two of the larger studies, providing extended follow-up on 366 patients, survival ranged from 60 to 69% at 3 years after transplant [1,[72][73][74], It must be emphasized that patient selection and graft origin may be important determinants of this apparent improvement in survival with transplanted diabetic patients as com pared to other treatment modalities. Thus, patients ac cepted for transplantation are often younger, have less end-organ damage and may be at an earlier point in the progression of their renal failure than are those selected for dialysis [74], Since most diabetics have been dialyzed prior to transplantation, it may be that, considering the significant 1st year mortality rate for diabetics on dialysis, such a period of dialysis therapy selects out the more healthy candidates for transplantation, thereby influenc ing posttransplant survival [74], In addition, calculation of survival data in terms of years posttransplant rather than years post-ESRD therapy tends to favor transplanta tion.…”

“…As in the nondiabetic population, pa tients receiving a kidney from a living related donor do appreciably better than those who are recipients of cad aver kidneys (table X). Reports from two groups indicate an 80-85% 1-year survival rate in 64 diabetics receiving a living related donor transplant [71,72], Furthermore, a 1-year survival of 90% has been reported in 55 diabetic patients who received an HLA-identical sibling graft, with very little additional mortality at 3 years [74], By comparison, nondiabetic HLA-identical living related donor transplant recipients experience survivals of 98 and 95% at 1 and 3 years, respectively [74], In the expe rience of the University of Minnesota group, HLA non identical grafts in 141 diabetics yielded a survival of 83% at 1 year, not very different from the figure for identical grafts, but the 3-year survival in the group of patients was only 64% [74], Overall, 1-year survival figures for non diabetic patients receiving living related donor trans plants are 84-98 and 72-95% for cadaver transplants [1.…”

“…In the former instance, a 1-year survival of 60-70% has been reported, declining to approximately 55% at 3 years [71,[72][73][74] (table X). Thus, diabetics fare best with an HLA-identical living related donor graft, demonstrating little difference from similarly treated nondiabetic patients.…”

“…While the recurrence of diabetic nephropathy in the transplanted kidney has been well documented, it has not led to graft loss thus far [53,74,80]. As was the case for patient survival, graft viability is improved by the use of HLA-identical or pretreated cad aver kidneys in diabetic patients [72,74], The sex of the recipient did not seem to influence graft survival in two reports [71,78], whereas in the University of Minnesota experience [74] females receiving HLA-identical grafts had a somewhat better graft survival than did male coun terparts at 1 and 3 years posttransplant.…”