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

Abstract

Background Transplantation with a diabetic donor kidney may have some benefits compared to remaining on the waitlist for selected patients. However, we found that some kidney transplant recipients have ongoing donor-transmitted diabetic kidney disease (DT-DKD) despite fair blood sugar control. This study aimed to survey the incidence and clinical pattern of DT-DKD in kidney transplant recipients. Methods We retrospectively reviewed the medical records of kidney transplantations in our hospital. We found 357 kidney transplantations from February 2006 to April 2018. Among these, 23 (6.4%) diabetic donor kidney transplantations were done in the study period. Results Among the 23 recipients, 6 (26.1%) displayed biopsy-proven DKD. Recipients with biopsy-proven DKD had longer dialysis vintage, higher proteinuria amount, lower last estimated glomerular filtration rate (eGFR), and a more rapid decline in the eGFR. The median fasting blood sugar level in the biopsy-proven DKD group was unexpectedly lower than the non-DKD group. Most of the pre-implantation frozen sections in biopsy-proven DKD group showed diabetic lesions worse than diabetic nephropathy (DN) class IIa. In the biopsy-proven DKD group, 5 recipients had no history of diabetes before or after transplantation. Among the 23 recipients, 5 (21.7%) were diagnosed with DT-DKD. Serial post-transplant biopsies showed the histological progression of allograft DN. Conclusions To the best of our knowledge, this is the first study to report the phenomenon of ongoing DT-DKD in kidney transplant recipients with fair blood sugar control. The zero-time pre-transplant kidney biopsy may be an important examination before the allocation of diabetic donor kidneys. Further study is needed to elucidate the possible mechanism of ongoing DT-DKD in non-diabetic recipients with fair blood sugar control as well as the impaction of pre-implantation diabetic lesion on the graft outcome.

Differences between Kidney Transplant Recipients from Deceased Donors with Diabetes Mellitus as Identified by Machine Learning Consensus Clustering

“…Overall, the findings from this unsupervised ML approach highlight opportunities to further improve the utilization of deceased donor kidney allografts coming from diabetic donors. Although diabetic donor kidneys are increasingly accepted, our data still shows that only a small percentage (5%) of transplanted kidneys were diabetic donor kidneys, which is similar to other reports ranging from 3.5% to 8.8% [5,[19][20][21][22][23]. The data from the UNOS registry suggested that approximately 40-50% of diabetic donor kidneys have been discarded each year from 2008 to 2019, and diabetic ECD donor kidneys had higher discarded rates, approximately 60% [3,24].…”

“…To address the missing values, the multiple imputation by chained equation (MICE) method [13] was employed for imputing the missing data. 17) 690 ( 24) 95 ( 14) 528 ( 12) 1189 (15) 459 ( 16) 191 ( 28 16) 420 ( 14) 132 ( 19) 674 ( 16) 0.008 1593 (20) 745 ( 26) 61 ( 9) 787 ( 18…”

Recoverability of Diabetic Nephropathy of Donor Kidney After Kidney Transplantation

“…Hsu et al reported that donor DN is transmissible to recipients ( 9 ). DN was transmitted in five of the six cases with donor DN, and the histologic class of DN progressed in three of the five cases.…”

“…In recent years, many efforts have been made to reduce the donor kidney discard rate, and understanding the natural course of donor DN is essential to reduce the discard rate in the reality that more than 40% of kidneys from diabetic donors are discarded ( 5 ). However, only few studies have evaluated the pathologic status and changes in the kidneys of DM donors and these studies included a small number of patients with DN ( 6 , 7 , 8 , 9 ). Therefore, to reach a more robust conclusion, biopsy results at regular intervals are needed in a larger number of patients.…”