Nephrol Dial Transplant (2002) 17: 1678-1683
© 2002 European Renal Association-European Dialysis and Transplant Association
Kidney transplantation in type 2 diabetic patients: a comparison with matched non-diabetic subjects
Diabetes and Transplant Centres, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Background. Because they generally are older and frequently have co-morbidities, patients with type 2 diabetes mellitus and end-stage renal disease seldom are selected for renal transplantation. Thus, information on transplantation results from controlled studies in this high-risk category of patients is scarce. We have compared the results of kidney transplantations in type 2 diabetic patients with carefully matched non-diabetic subjects.
Methods. All first cadaveric renal transplants performed in type 2 diabetic patients from January 1, 1988 to December 31, 1998 in our centre were included. Non-diabetic controls were individually matched with diabetic patients with respect to year of transplantation, sex, age, selected immunological parameters, and graft cold ischaemia.
Results. We included 64 type 2 diabetic and 64 non-diabetic patients who were followed for a mean period of 37±27 and 41±31 months, respectively, after renal transplantation. Patient survival at 1 and 5 years post-transplant was 85 and 69 vs 84 and 74% (P=0.43, NS), while graft survival rates censored for patient death were 84 and 77 vs 82 and 77% for diabetic and non-diabetic subjects, respectively (P=0.52, NS). With graft survival results not censored for death with functioning graft, no significant change was seen (diabetic vs non-diabetic group: 77 and 54 vs 73 and 61%, P=0.19, NS). Age, but not the presence of diabetes, was the only factor significantly affecting patient survival when both patient groups were pooled. With regard to post-transplant complications requiring hospitalization, there was a significant difference only in the number of patients who had amputations (diabetic vs non-diabetic group: 8 vs 0, P=0.01).
Conclusions. Patient and graft survival after kidney transplantation was similar in type 2 diabetic and matched non-diabetic subjects, with more amputations occurring in the diabetic group. Thus, at a single-centre level renal transplantation results almost equivalent to those in non-diabetic patients may be achieved in type 2 diabetes mellitus.
Keywords: kidney transplantation; outcome; type 2 diabetes mellitus
Correspondence and offprint requests to: Petr Boucek, MD, Diabetes Centre, IKEM, Videnska 9, Prague 4, CZ-140 21, Czech Republic. Email: petr.boucek{at}medicon.cz
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