Kidney Transplantation in Diabetic Patients: Clinical Study in a Single Center

Lee, Sang Cheol; Youn, Hyun Jin; Goo, Young Suck; Han, Seung Hyeok; Kang, Shin Wook; Choi, Kyu Hun; Lee, Ho Yung; Han, Dae Suk; Kim, Soon Il; Kim, Yu Seun; Park, Ki Il

Abstract

PURPOSE: End stage renal disease caused by diabetic nephropathy is increasing throughout the world. In earlier years, the results of kidney transplantation in diabetics were not as good as those in non-diabetics and the presence of diabetes has been considered as contraindication at many centers. But the survival rate of diabetic patients treated with transplantation has improved in recent years. In this study we compared the results of kidney transplantation in diabetic patients group with those of non-diabetic patients group.
METHODS
We reviewed our experience in a single center with 1,386 kidney transplantation patients in non-diabetic patients, compared with 31 kidney transplantation patients in diabetic patients. The clinical characteristics such as age, sex, duration of diabetes mellitus, serum albumin, blood urea nitrogen, hemoglobin, glycated hemoglobin, creatinine clearance, and morbidity were retrieved from medical charts.
RESULTS
For diabetic transplantation patients one- and five year patient survival were 92.3% and 84%; for non-diabetic transplantation patients one- and five year patient survival were 98.7% and 93.4%. It showed statistically significant differences in patient survival between two groups. We analyzed graft survival in two ways. When all deaths were not censored, the graft survival rate of diabetic transplantation patients was significantly lower than that of non-diabetic transplantation patients: 80.6% vs 85.8% at 5 years and 27.3% vs 68.6% at 10 years (P=0.04). But the graft survival rate did not differ significantly between the diabetic and non-diabetic patients when deaths were censored: 95% vs 91.7% at 5years and 63.3% vs 79.5% at 10 years (P=0.96) In the analysis of risk factors affecting patient mortality, presence of DM and graft loss were associated with mortality and its odds ratios were 8.94 and 6.33 respectively.
CONCLUSION
The overall patient survival and graft survival were significantly worse in the diabetic transplantation patient group than the non-diabetic transplantation patient group. But graft survival was not different between two groups when death was censored. This means that graft survival in diabetic transplantation group is not different actually with non- diabetic transplantation group when comorbidities are fully evaluated and treated before transplantation.