Inferior long-term outcome of renal transplantation in patients with diabetes mellitus.
OBJECTIVE
To retrospectively review the long-term outcome of renal transplant in diabetics at Mubarak Al-Kabeer Hospital and Hamad Al-Essa Organ Transplant Center, Kuwait from 1983 to 1998.


METHODS
There were 631 renal transplant patients, comprising 79 (12.5%) patients with pretransplant diabetes mellitus (pre-TDM), 117 (18.5%) patients with post-transplant diabetes mellitus and 435 (69%) nondiabetics (ND). Subjects with post-transplant diabetes mellitus were excluded from the comparative analysis. Distribution of sex, source of donors and mode of immunosuppression were similar in pre-TDM and ND groups.


RESULTS
Fifty-three (67%) recipients in pre-TDM and 90 (20.5%) in the ND group (p < 0.01) were above 45 years of age. However, 26 (33.3%) pre-TDM and 345 (79.5%) ND were below age 45. Among those who died, coronary artery disease led to death in 36% of pre-TDM and 27% in ND. Hyperlipidemia requiring drug therapy was observed in 37% pre-TDM and 6% ND. The incidence of severe infections was nearly twice in pre-TDM over ND recipients (1.9 vs. 1.0 per patient, p < 0.001). Acute rejection episodes were more frequently seen in pre-TDM (43%) than ND (33%), however the difference was not statistically significant. The patient survivals at 1, 5, 10, 14 years were significantly lower in pre-TDM (84, 65, 58 and 58%, respectively) than in ND (97, 93, 86 and 82%, respectively). The major contributory factors were severe infections and coronary artery disease. The cumulative graft survival showed a similar pattern (52% in pre-TDM, 73% in ND at 10 years). However, when death is excluded, the 10-year pure graft survival probability was similar for the pre-TDM and ND groups (76% vs. 80%).


CONCLUSIONS
Our study indicates poor patient survival in pre-TDM due to coronary artery disease and infections, whereas the pure long-term graft survival was equally good in pre-TDM and ND transplant recipients.
Department of Medicine, Mubarak Al-Kabeer Hospital, PO Box 24923, 13110 Safat, Kuwait.
M R Narayanan
MR
Nampoory
Kaivilayil V
KV
Johny
Jamal N
JN
Costandi
Ram K
RK
Gupta
Madhavan P
MP
Nair
Mohmoud
M
Samhan
Ibrahim A
IA
al-Muzairai
Mustafa
M
al-Mousawi
D000328:Adult; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012189:Retrospective Studies; D015996:Survival Rate; D013995:Time; D016896:Treatment Outcome