Impact of diabetes mellitus on transplantation.
1. In total, 99,933 kidney alone transplants were performed in the US from 1995-2002. Of these, 11,251 transplants were for type 1 diabetic recipients, 7,772 transplants were for type 2 diabetic recipients and 80,910 for non-diabetic recipients. Approximately 20% of all kidney transplants were performed for diabetic recipients during this period. 2. The mean age of recipients and donors has been increasing annually since 1995 for type 1 and type 2 diabetic recipients. The same trend was noted for the mean BMI of recipients. 3. Kaplan-Meier estimates of kidney transplant survival for each variable showed that the age of recipients and donors, BMI of recipients, recipients' race, HLA-DR3/4 positive of the recipients, types of primary payment source, presensitization of the recipients, donor type, number of HLA mismatches, and cold ischemia time were significantly associated with the patient and kidney graft survival rates for type 1 diabetic recipients. 4. When adjusted for 15 potential risk factors in the Cox proportional hazard model, recipient age and sex, source of primary payment, donor age, donor type, and the number of HLA mismatches were independent and significant predictors of patient survival. With respect to kidney graft survival, recipient age and race, source of primary payment, peak value of percent panel-reactive antibodies, donor age, donor type, and the number of HLA mismatches were independent and significant predictors. 5. Kaplan-Meier estimates of the entire survival of a kidney transplant for each variable showed that recipient and donor age, types of primary payment source, donor type, number of HLA mismatches, and cold ischemia time were significantly associated with kidney graft survivals for type 2 diabetic recipients. 6. When adjusted for 15 potential risk factors in the Cox proportional hazard model, recipient age and BMI, source of primary payment, donor age, and donor type were independent and significant predictors of patient survival. With respect to kidney graft survival, recipient age, and BMI, source of primary payment, donor age, donor type, and number of HLA mismatches were independent and significant predictors. 7. In conclusion, our data suggests that recent kidney transplants have been performed among older diabetic patients with higher risk. Further studies, considering all variables implicated in the prognosis of diabetes and its impact on graft and patient survival are needed in order to improve the outcome of diabetic recipients after kidney transplantation. This may also help us optimize the use of limited kidney grafts.
Waki
Kayo
K
Terasaki Foundation Laboratory, Los Angeles, California, USA.
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery; D003928:Diabetic Nephropathies / Q000150:complications / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014019:Tissue Donors; D014481:United States / Q000453:epidemiology
D006680:HLA Antigens