Kidney transplantation in type 2 diabetic patients: a comparison with matched non‐diabetic subjects

• Published in: Nephrology, dialysis, transplantation Vol. 17; no. 9; pp. 1678 - 1683
• Main Authors: Boucek, Petr, Saudek, Frantisek, Pokorna, Eva, Vitko, Stefan, Adamec, Milos, Koznarova, Radomira, Lanska, Vera
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.2002
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure; Case-Control Studies; Diabetes Mellitus, Type 2 - surgery; Diabetic Nephropathies - surgery; Emergency and intensive care: renal failure. Dialysis management; Follow-Up Studies; Graft Survival - physiology; Humans; Intensive care medicine; Kidney Diseases - classification; Kidney Diseases - surgery; kidney transplantation; Kidney Transplantation - mortality; Kidney Transplantation - physiology; Kidney Transplantation - statistics & numerical data; Medical sciences; Middle Aged; outcome; Peritoneal Dialysis, Continuous Ambulatory; Renal Dialysis; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate; Time Factors; Treatment Outcome; type 2 diabetes mellitus; Endocrinopathy; Human; Kidney disease; Urinary system disease; Terminal stage; Transplantation; Hospitalization; Homotransplantation; Non insulin dependent diabetes; Survival; Morbidity; Surgery; Risk factor; Complication; Comparative study
• ISSN: 0931-0509; 1460-2385; 1460-2385
• DOI: 10.1093/ndt/17.9.1678

Background. Because they generally are older and frequently have co‐morbidities, patients with type 2 diabetes mellitus and end‐stage renal disease seldom are selected for renal transplantation. Thus, information on transplantation results from controlled studies in this high‐risk category of patients is scarce. We have compared the results of kidney transplantations in type 2 diabetic patients with carefully matched non‐diabetic subjects. Methods. All first cadaveric renal transplants performed in type 2 diabetic patients from January 1, 1988 to December 31, 1998 in our centre were included. Non‐diabetic controls were individually matched with diabetic patients with respect to year of transplantation, sex, age, selected immunological parameters, and graft cold ischaemia. Results. We included 64 type 2 diabetic and 64 non‐diabetic patients who were followed for a mean period of 37±27 and 41±31 months, respectively, after renal transplantation. Patient survival at 1 and 5 years post‐transplant was 85 and 69 vs 84 and 74% (P=0.43, NS), while graft survival rates censored for patient death were 84 and 77 vs 82 and 77% for diabetic and non‐diabetic subjects, respectively (P=0.52, NS). With graft survival results not censored for death with functioning graft, no significant change was seen (diabetic vs non‐diabetic group: 77 and 54 vs 73 and 61%, P=0.19, NS). Age, but not the presence of diabetes, was the only factor significantly affecting patient survival when both patient groups were pooled. With regard to post‐transplant complications requiring hospitalization, there was a significant difference only in the number of patients who had amputations (diabetic vs non‐diabetic group: 8 vs 0, P=0.01). Conclusions. Patient and graft survival after kidney transplantation was similar in type 2 diabetic and matched non‐diabetic subjects, with more amputations occurring in the diabetic group. Thus, at a single‐centre level renal transplantation results almost equivalent to those in non‐diabetic patients may be achieved in type 2 diabetes mellitus.