Nephrol Dial Transplant (2001) 16: 1686-1691
© 2001 European Renal Association-European Dialysis and Transplant Association
Outcome of cadaver kidney transplantation in 23 patients with type 2 diabetes mellitus
Departments of 1Nephrology, 2Endocrinology and 3Kidney transplantation, Cliniques Universitaires St-Luc, Université Catholique de Louvain (UCL), Bruxelles, and Departments of 4Nephrology and 5Abdominal Transplantation Surgery, Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit van Leuven (KUL), Leuven, Belgium
Background. Type 2 diabetes mellitus (DM) is a growing cause of end-stage renal failure worldwide. Yet, only a minority of type 2 diabetics are considered today for kidney transplantation (KT). The scarcity of data on the outcome of such patients after KT prompted us to review our experience.
Methods. Between 1 January 1983 and 30 June 1996, 23 patients with type 2 DM received a first cadaver KT at a mean age of 57±9 (41–73) years, after a dialysis period ranging from 5 to 72 (mean 25±18) months. Only nine patients had a history of coronary and/or peripheral vascular disease before KT. All were given cyclosporin- or tacrolimus-based immunosuppression. Post-KT follow-up ranged from 4 to 181 (mean 70±38) months. Outcome analysis focused on the impact of cardiovascular complications.
Results. Patient survival at 1, 5 and 8 years was 91, 83 and 76% respectively. Death was due to infection in three patients and to a cardiovascular event in two. The actuarial risk of coronary, cerebrovascular, peripheral vascular, and any cardiovascular event after KT was 14, 13, 9 and 30% at 1 year, 20, 13, 50 and 58% at 5 years, and 20, 46, 66 and 72% at 8 years respectively. Post-KT hospital readmissions averaged 10 days/patient-year and were mostly related to the management of peripheral vascular disease.
Conclusion. KT is an excellent therapeutic option for selected patients with type 2 DM. Peripheral vascular disease is the leading cause of morbidity following KT. KT should be considered in type 2 diabetics with a low/medium cardiovascular risk.
Keywords: coronary artery disease; kidney transplantation; type 2 diabetes mellitus; vascular complications
Correspondence and offprint requests to: Yves Pirson MD, Cliniques Universitaires St-Luc, Department of Nephrology, av. Hippocrate 10, B-1200 Bruxelles, Belgium.
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