Diabetes Increases Post-Transplant Mortality Risk

The diabetic donor and recipient group had a 3.14 times greater risk of death at 5 years.
The diabetic donor and recipient group had a 3.14 times greater risk of death at 5 years.
The following article is part of conference coverage from the 2017 American Transplant Congress (ATC) in Chicago, Illinois. Renal and Urology News' staff will be reporting breaking news associated with research conducted by leading experts in transplantation. Check back for the latest news from ATC 2017.

Diabetes in the kidney recipient, the deceased donor, or both, is associated with worse post-transplant survival, researchers reported at the 2017 American Transplant Congress in Chicago.

Of 706 recipients of deceased-donor kidneys at Houston Methodist Hospital in Texas during 2006–2014, 23 had diabetes and received a diabetic kidney, 26 were free of the disease and received a diabetic kidney, 211 had diabetes and received a non-diabetic kidney, and 446 had no diabetes and received a non-diabetic kidney. Older male patients with higher body mass index (BMI) tended to be given deceased-diabetic kidneys from donors who were also older and had a higher BMI.

At 5 years after transplant, patient mortality was 8.5% in the non-diabetic donor and recipient group, compared with 3.8% in the diabetic-donor-only group, 15.6% in the diabetic-recipient-only group, and 21.7% in the diabetic donor and recipient group, Faiza N. Khan, DO, of Houston Methodist Hospital, and colleagues reported in a poster presentation. The diabetic donor and recipient group had a 3.14 times greater risk of death at 5 years compared with donor and recipient pairs free of diabetes. 

“Recipients with diabetes have a significant increase in patient mortality than nondiabetic recipients. This is likely due to diabetes being a known risk factor for micro and macrovascular disease,” Dr Khan told Renal & Urology News.

Although the study suggests that diabetic recipients of diabetic donor organs had the worst survival, the results may be limited by the small study population and the fact that diabetic lesions in these kidneys were not advanced. "However, it is evident that recipient diabetic status has a greater impact than donor diabetic status," according to Dr Khan.

Graft survival at 5 years was 83.4% in the non-diabetic donor and recipient group, 92.3% in the diabetic-donor-only group, 77.1% in the diabetic-recipient-only group, and 66.6% in the diabetic donor and recipient group. Recipients and donors free of diabetes tended to have higher panel reactive antibodies, longer dialysis vintage, and underlying glomerulonephritis.

With regard to the study's potential clinical implications, the investigators highlighted that diabetic nephropathy is seen in only 30-40% of people with diabetes. "The Kidney Donor Profile Index, a calculation that gives a numerical value to each donated kidney, is used by surgeons to decide which kidneys to accept and is heavily influenced by diabetes status of the donor. The bigger clinical implication from this study is exactly this: The KDPI which uses diabetes status may result in a higher discard rate of kidney organs," Dr Khan stated.

Visit Renal and Urology News' conference section for continuous coverage from ATC 2017.

Reference

Khan F, Suki W, Nguyen D, Graviss E. Outcomes of Kidney Transplantation Using Deceased Diabetic Donors. [abstract]. Am J Transplant 2017;17 (suppl 3). Poster presented at the American Transplant Congress in Chicago, April 29–May 3, 2017. Abstract A103.

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