Diabetic kidneys can safely expand the donor pool

Abstract

Background: The demand for organs has increased exponentially with a new name added to the United States waiting list every 16 min. As such, kidneys from medically marginal donors are being considered for transplantation more frequently, including kidneys from individuals already at risk for renal disease, e.g., diabetic donors.

Methods: We compared outcomes when using kidneys from donors with type 1 diabetes mellitus (D1) or type 2 diabetes mellitus (D2) at our center as a function of time. All patients with available data who underwent renal transplantation were evaluated (n=2013).

Results: Forty-two individuals were recipients of D1 or D2 donor kidneys. Thirty of these individuals did not have diabetes (R0). All patients received quadruple sequential immunosuppression with cyclosporine (CsA) or tacrolimus (FK506). Donor serum creatinine (Scr) values were not significantly different. D2 kidneys came from older donors (mean age, 56+/-10.4 years; P< or =0.01 vs. D1 and D0 donors). Mean discharge Scr was greater in nondiabetic D2 recipients (D2/R0, 2.45+/-1.3 mg/dl; P=0.0016 vs. D0/R0), and transplantation of D1 or D2 kidneys was associated with a significantly increased frequency of posttransplant proteinuria (P=0.0089). Interestingly, R0 recipients of D1 or D2 kidneys were more likely to initiate oral hypoglycemic therapy after transplant (P=0.04). However, rejection episodes were not significantly different among groups, and long-term graft survival and patient survival were similar among groups.

Conclusions: These data suggest that diabetic kidneys can be safely used without risk to patient or graft survival. Preexisting diabetic injury in the donor may increase the risk for proteinuria, compromised renal function, and posttransplant glucose intolerance.