Increased Mortality Due to Cardiovascular Disease in Type 1 Diabetic Patients Transplanted for End‐stage Renal Failure

Kumar, Sudhesh; Merchant, Mahendra; Dyer, Philip A.; Martin, Sue Ellen; Hutchison, Alastair J.; Johnson, Robert W.; Boulton, Andrew J.M.; Gokal, Ram

doi:10.1111/j.1464-5491.1994.tb00259.x

Cited by 17 publications

(19 citation statements)

References 12 publications

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“…There are varying reports on long-and short-term survival rates of diabetic recipients compared to those of ND [7,10,[12][13][14]. While Eckberg and Christensson [7] and Shaffer et al [13] reported similar rates, in the present study, pre-TDM had lower survival rates than ND.…”

Section: Discussioncontrasting

confidence: 52%

“…Vascular disease is probably the major contributing factor to patient morbidity and mortality following transplantation in diabetic recipients [10,11]. In a 5-year survival of diabetic renal allograft recipients, diabetic patients without vascular disease (79%) had a significantly higher survival rate than those with vascular disease (8%) [13].…”

Section: Discussionmentioning

confidence: 99%

“…Some centers have reported higher mortality and lesser patient and graft survivals in diabetics compared to ND [7,8]. However, other authors have found similar patient and graft survival in both these groups [7][8][9][10][11][12]. This prompted us to review our experience with transplantation in uremic diabetics and compare it with that in ND.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2002

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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.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2002

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“…The most common cause of death in renal transplant recipients and in diabetic patients is CV disease (6–7). Although we found no difference in overall rates of death between the MMF and AZA groups, MMF treatment was associated with a 20% decreased risk of CV death compared with treatment with AZA.…”

Section: Discussionmentioning

confidence: 99%

“…However, with reported 33% 5‐yr survival for diabetic ESRD patients treated with dialysis compared with 61–83% for patients treated with renal transplantation, transplantation is now the preferred option for these patients (2–3). While graft function and graft survival are similar in patients with and without diabetes (4–5), post‐transplantation mortality, specifically mortality related to cardiovascular (CV) causes, is higher in diabetic patients than in non‐diabetic patients (6–7).…”

mentioning

confidence: 99%

Mycophenolate mofetil vs. azathioprine is associated with decreased acute rejection, late acute rejection, and risk for cardiovascular death in renal transplant recipients with pre‐transplant diabetes

David¹,

Morris²,

Steffen³

et al. 2005

Clinical Transplantation

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Outcomes specifically in mycophenolate mofetil (MMF)-treated diabetic renal transplant patients have not been previously reported. This study compared acute rejection (AR), late acute rejection (LAR), patient survival [and specifically death from cardiovascular (CV), infectious and malignant causes], incidence of post-transplant malignancies, and graft loss in MMF- or azathioprine (AZA)-treated renal transplant patients with pre-transplant diabetes. Outcomes were compared between MMF- (n = 14 144) and AZA- (n = 3001) treated diabetic patients using the Scientific Registry of Transplant Recipients data on all U.S. adult renal transplants performed between 1995 and 2002. Statistical analyses included Kaplan-Meier survival analysis, Cox multivariable regression and chi-square tests. MMF patients had less AR compared with AZA-treated patients (23.5% vs. 28.3%, p < 0.001) and less risk for LAR over 4 yr [hazard ratio (HR): 0.64, 95% CI 0.44, 0.92; p = 0.02]. While time to any-cause death did not differ between the groups, MMF treatment was associated with a 20% decreased risk of CV death (HR: 0.80, 95% CI 0.67, 0.97; p = 0.020) compared with AZA treatment. MMF patients also had a lower incidence of malignancies than AZA patients (2.2% vs. 3.7%, p < 0.001). These results suggest treatment with MMF compared with treatment with AZA in diabetic transplant patients is associated with less AR, less risk of LAR, a decreased risk of CV death, and a lower incidence of malignancies.

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Similar treatment success rate after renal transplantation in diabetic and nondiabetic patients due to improved short- and long-term diabetic patient survival

Ekberg

Christensson

1996

Transpl Int

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In the early era of transplantation, it was common practice to exclude diabetic patients since the outcome in such cases was usually poor. At our center in Malmö, Sweden, diabetic nephropathy was never regarded as a contraindication. During the 22-year period from 1972 to 1993, 223 renal allografts were transplanted in 189 uremic diabetics, representing 24% of all renal transplant recipients (n = 788). The two subgroups - patients with and without diabetes - did not differ significantly in graft survival rates for the 22-year period, which was characterized by a successive improvement in the success rate that was especially striking in the diabetic nephropathy subgroup. Among transplantations performed before 1988, the overall patient survival rate was significantly lower in the diabetic subgroup than in the remainder. After 1988 (when a series of new procedures had been adopted), the patient survival rate in the diabetic subgroup was similar to that in the nondiabetic subgroup, a similarity that persisted for at least 5 years. The 1st year post-transplant mortality rate was reduced in diabetic patients from 24% before 1988 to 0% in those transplanted after 1988. In the 22-year period as a whole, cardiovascular or cerebrovascular events were the most common cause of death in both subgroups; the risk of cardiovascular or cerebrovascular death was reduced after 1988, and the rates were similar in both subgroups. The improved success rate of renal transplantation in patients with diabetic nephropathy supports continuation of the renal transplant program, which is based on careful management of the early stages of the disease.

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Increased Mortality Due to Cardiovascular Disease in Type 1 Diabetic Patients Transplanted for End‐stage Renal Failure

Cited by 17 publications

References 12 publications

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

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

Mycophenolate mofetil vs. azathioprine is associated with decreased acute rejection, late acute rejection, and risk for cardiovascular death in renal transplant recipients with pre‐transplant diabetes

Similar treatment success rate after renal transplantation in diabetic and nondiabetic patients due to improved short- and long-term diabetic patient survival

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