The impact of donor and recipient diabetes on renal transplant outcomes

Abstract

The use of diabetic kidneys is increasing worldwide with better outcome than being on waitlist and possible reversal of diabetic changes in transplanted kidneys. But particular caution is warranted in diabetic donor-recipient combination. Total 1223 deceased donor kidney transplants were performed at our center between 2008 and 2018. 689 from non-diabetic donor (NDD) to non-diabetic recipient, 400 from nondiabetic donor to diabetic recipient, 97 from diabetic to non-diabetic recipient, and 32 from diabetic donor (DD) to diabetic recipient. The DD was older than NDDs (median age 48 vs 39 years, P < 0.0001). DD had higher BMI (35.6 vs 26.9, P < 0.0001), higher KDPI (74% vs 37%, P < 0.0001), and higher terminal creatinine (1.10 mg/dl vs 0.95 mg/ dl, p 0.0046) than the NDD. Diabetes recipients were comparatively older (57 vs 54, P < 0.001). DD recipients had higher serum creatinine at 6 months (1.70 vs 1.50 mg/ dl, p 0.00304) and 2 years post-transplant (1.70 vs 1.50 mg/dl P < 0.0002). DD recipients had more favorable end CPRA than NDD recipients (77.5% at 0% vs 67.4% at 0, P = 0.0074). Ten-year patient and graft survival was best in NDD-recipient pair and worse in DD-recipient pair. Diabetic donor kidneys to diabetic recipients have lower 1-, 3-, and 5-year graft survival.

Distinct clinical profiles and post-transplant outcomes among kidney transplant recipients with lower education levels: uncovering patterns through machine learning clustering

“…Limiting time on dialysis is beneficial and a pretransplant dialysis duration >24 months has been found to be a significant risk factor associated with poor death-censored graft survival [ 40 ]. Regardless of the origin of the donor organ, adjusted mortality rates are 75% higher with rates of adjusted graft losses 25% higher in diabetic recipients [ 41 , 42 ]. This may be more likely related to the highest 2-year mortality in this cluster.…”

Histological findings of diabetic kidneys transplanted in non-diabetic recipients: a case series

“…Diabetic donors’ potential to expand the donor pool has been extensively analyzed in large cohort studies; it has been ascertained that receiving a kidney from a DD does assure a survival benefit, compared to remaining on the waiting list and that patient and graft survival depend on the status of the recipient. Indeed, the worst outcomes are seen when diabetes is present in both the donor and the recipient, and the diabetic recipient of a non-diabetic kidney has a worse evolution then a non-diabetic recipient [ 3 , 4 , 10 , 12 , 13 ]. Although the differences in organ and patient survival rates between diabetic and non-diabetic donors are slight, the discard rate of DD is still too high and these organs are not utilized at their fullest potential [ 13 , 14 ].…”

“…The donors in our cohort had the highest number of years (54–77 y–o) and KDPI (80–100%) compared to the other published records. Singh et al have recently reported 10-year graft and patient survival data analyzing the mis- matches in donor and recipient diabetes status; they reported a mean donor age of 36–51 years in the different groups, while the donors in the group DD- ND recipient had a mean age of 47 and a mean KPDI of 71% [ 4 ]. Similarly, Kahn describes a population of 38-year-old donors, 45-year old in the match DD-ND recipient [ 10 ].…”

“…Again, they are the oldest among the cases reported in the literature. In Truong the age of recipients was 35–73 [ 9 , 15 ]; recipients reported by Cohen were 55 (46–63) and 56 (47–64) [ 3 , 13 ]; Khan described recipients with mean age 58 (49–66) years [ 10 ], the recipients reported by Singh were 54 (47–62) [ 4 ]; the age of the recipients reported by Mohan in the subgroup of diabetic-ECD donors is of 59.4 ± 6.2 years [ 12 ]. Even in marginal pairs like these, with very high-risk donors and old recipients, we did not observe a severe worsening at histology or in terms of GFR; they were both similar to the published data that refer to less comorbid donor-recipient couples [ 7 , 9 , 15 ].…”

“…Nevertheless, the long-term survival of kidneys from diabetic donors is significantly lower than that of kidneys from non-diabetic (ND) donors, although the absolute difference in graft survival is small [ 2 ]. It has been demonstrated that the negative impact of donor diabetes on graft and patient survival is dependent on the recipient diabetic status: DD kidneys transplanted into diabetic recipients have been associated with the highest risk of all-cause graft loss and patient mortality, compared to all other donor/recipient combinations in terms of diabetic status [ 3 , 4 ].…”