Outcomes of Kidney Transplantation using Deceased Donors with History of Diabetes

Deceased diabetic kidneys are increasingly utilized in transplantation. The relationship of donor's history of diabetes to clinical and histological outcomes was examined. Forty-nine diabetic deceased donor kidneys (D-DM) were transplanted into 26 normal (R-N/D-DM) and 23 diabetic recipients (R-DM/D-DM) and compared to 211 diabetic recipients of normal kidneys(R-DM/D-N) and 466 normal recipients of normal kidneys (R-N/D-N). Patient survival at 5 years was 89.7% in R-N/D-N, 96.2% in R-N/D-DM, 80.1% in R-DM/D-N and a 71.6% in R-DM/D-DM (p=0.008). Death-censored graft survival at 5 years was 86.3% in R-N/D-N, 87.4% in R-N/D-DM, 93.5% in R-DM/D-N and 87.5% in R-DM/D-DM (p=0.24). Multivariable regression analysis showed that compared to non-diabetic recipients, diabetic recipients had a 2-3 fold increased risk of mortality. In this cohort there was no impact on death-censored graft survival of diabetic donor status. Only 6 of 26 post perfusion biopsies showed evidence of diabetic nephropathy (<IIa) and on repeat biopsies 70% showed no evidence of progression. Survival of recipients of diabetic donor kidneys appears dependent on the diabetic status of the recipient with the worst survival being in diabetic recipients of a diabetic donor kidney. In this cohort, donor kidneys had paucityof structural diabetic lesions and most did not show progression.