Outcome of Renal Transplantation in Patients With Type 2 Diabetic Nephropathy: A Single-Center Experience

doi:10.1016/j.transproceed.2014.12.047

Transplantation Proceedings

Volume 47, Issue 3, April 2015, Pages 608-611

https://doi.org/10.1016/j.transproceed.2014.12.047 Get rights and content

Highlights

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We examined the effect of renal transplantation for type 2 diabetic nephropathy (DM).
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We compared the outcome of renal transplantation for DM with that for NDM.
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Patient and graft survival rates were similar in the DM and NDM groups.
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The incidence of post-transplantation CV events was higher in the DM group.
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DM is an independent risk factor for CV events after renal transplantation.

Abstract

Background

Renal transplantation has been established as a treatment for end-stage renal disease (ESRD) due to diabetic nephropathy. However, few studies have focused on the outcome after renal transplantation in patients with ESRD and type 2 diabetic nephropathy. To investigate the effect of renal transplantation on ESRD with type 2 diabetic nephropathy, we retrospectively analyzed patients who received renal transplantation at our facility. This study aimed to compare the outcome of renal transplantation for type 2 diabetic nephropathy with that for nondiabetic nephropathy.

Methods

We studied 290 adult patients, including 65 with type 2 diabetic nephropathy (DM group) and 225 with nondiabetic nephropathy (NDM group), who underwent living-donor renal transplantation at our facility from February 2008 to March 2013. We compared the 2 groups retrospectively.

Results

In the DM and NDM groups, the 5-year patient survival rates were 96.6% and 98.7%, and the 5-year graft survival rates were 96.8% and 98.0%, respectively, with no significant differences between the groups. There were no significant differences in the rates of surgical complications, rejection, and infection. The cumulative incidence of postoperative cardiovascular events was higher in the DM group than in the NDM group (8.5% vs 0.49% at 5 years; P = .002).

Conclusions

Patient and graft survival rates after renal transplantation for type 2 diabetic nephropathy are not inferior to those for recipients without diabetic nephropathy. Considering the poor prognosis of patients with diabetic nephropathy on dialysis, renal transplantation can provide significant benefits for these patients.

Section snippets

Materials and Methods

We studied a total of 290 patients, including 65 with ESRD and type 2 diabetic nephropathy (DM group) and 225 with ESRD and nondiabetic nephropathy (NDM group) who underwent living-donor renal transplantation at our facility from February 2008 to March 2013. The demographics of the 2 groups are presented in Table 1. ESRD patients with type 2 diabetic nephropathy were defined as those with preexisting diabetic retinopathy and diagnosed by a nephrologist. A comparative examination was performed

Results

Table 1 presents the patients' clinical characteristics. The mean age and the male-to-female ratio in the DM group were higher than those in the NDM group (P < .001; P = .004; respectively). The percentage of patients with preemptive renal transplantation in the DM group was lower than that in the NDM group (P = .033). The morbidity of pre-transplantation CV diseases was significantly higher in the DM group than in the NDM group (P < .001). No significant differences were found in

Discussion

According to the statistical data of the Japanese Society for Dialysis Therapy, the 5-year survival rate of dialysis patients after the onset of dialysis, including all of the primary diseases, is 59.8% [1]. Additionally, the 5-year survival rate of patients with diabetic nephropathy as a primary disease is estimated to be only 50% [1]. Type 2 diabetes is increasing on a global scale. However, few studies have focused on the outcome after renal transplantation in patients with ESRD and type 2

Conclusion

This study shows that patient and graft survival rates after renal transplantation in patients with type 2 diabetic nephropathy are not inferior to those with nondiabetic nephropathy over 5 years. Considering the poor prognosis of patients with diabetic nephropathy after the onset of dialysis, performing renal transplantation for ESRD in patients with type 2 diabetic nephropathy is beneficial. The incidence of post-transplantation CV events was significantly higher in the DM group than in the

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Citation Excerpt :
In our study, the graft survival rates for 1-year and 3-year were 99.1% and 99%, respectively. Noguchi et al reported that in the DM and non-diabetic groups the 5-year graft survival rates were 96.8% and 98%, respectively [7]. In our study, cardiac death (54.5%) was the most common cause of mortality.
An increasing proportion of kidney recipients have diabetes mellitus (DM). Some concerns have been raised about the kidney transplantation results in diabetic patients. Therefore, we assessed the effect of DM on morbidity and mortality of diabetic patients with renal transplantation.
We retrospectively studied adult patients with and without DM who underwent living donor transplantation between 2007 and 2016. Information concerning demographic and clinical data were retrospectively analyzed by reviewing the patient files.
Of the 1536 transplant recipients, 126 (8%) had diabetes mellitus (mean age 49.4 ± 11.8) and 525 patients were evaluated in the non-diabetic control group (mean age 36.2 ± 15.9). The diabetic and non-diabetic patient groups had a mean follow-up after kidney transplantation 42.5 months (0.27-101.7 months) and 58.8 ± 10.6 months, respectively. In the diabetic patient group, only 3 patients had lost graft and 13 patients were exitus. Three patients had lost graft and 5 patients were exitus in non-diabetic patient group. Cardiac death (54.5%) was the most common cause of mortality in diabetic group. The 6-year patient and graft survival rates are 84.9% and 95.3%; 97.5% and 97.2% in the diabetic and non-diabetic patient groups, respectively.
Both infection and cardiovascular diseases increase morbidity and mortality in renal transplant patients with diabetes mellitus. The mortality risk of diabetic patients after renal transplantation is higher than the non-diabetic kidney recipients. Therefore, diabetic patients need meticulous cardiac evaluation before renal transplantation and a close follow-up, in terms of infection, after transplantation.
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10th Japan-Korea transplantation forumKidney transplantationOutcome of Renal Transplantation in Patients With Type 2 Diabetic Nephropathy: A Single-Center Experience

Highlights

Abstract

Background

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Conclusion

Urology

Am J Transplant

Am J Transplant

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Am J Kidney Dis

10th Japan-Korea transplantation forum
Kidney transplantation
Outcome of Renal Transplantation in Patients With Type 2 Diabetic Nephropathy: A Single-Center Experience