title: Outcome of deceased donor renal transplantation in diabetic nephropathy: a single-center experience from a developing country.
abstract: BACKGROUND
  Type 2 diabetes mellitus (DM) is the commonest cause of end-stage renal disease (ESRD) worldwide. Renal transplantation (RTx) is the best therapeutic modality for such patients. First-degree relatives of patients with type 2 DM have high risk of diabetes/pre-diabetes. Parents are often too old to be suitable donors, and siblings/children/spouse are either not suitable/acceptable or do not come forward for organ donation. This leaves deceased donation (DD) as only suitable donors. Data scarcity on DDRTx outcome in diabetic nephropathy (DN) prompted us to review our experience. This retrospective single-center 10-year study was undertaken to evaluate patient/graft survival, graft function, rejection episodes, and mortality in these patients.
  
  
  METHODS
  Between January 2001 and March 2011, thirty-five DN-ESRD patients underwent DDRTx in our center following cardiac fitness assessment of recipients. All patients received single-dose rabbit-anti-thymocyte globulin for induction and steroids, calcineurin inhibitor, and mycophenolate mofetil/azathioprine for maintenance immunosuppression. Mean recipient age was 49.66 ± 6.76 years, and 25 were men. Mean donor age was 50 ± 16.45 years, 23 were men.
  
  
  RESULTS
  Over a mean follow-up of 2.28 ± 2.59 years, patient and graft survival rates were 68.5% and 88.5%, respectively, with mean SCr of 1.9 ± 0.62 mg/dl. Delayed graft function was observed in 34.3% patients, and 25.7% had biopsy-proven acute rejection; 31.5% patients died, mainly because of infections (22.8%), coronary artery disease (2.86%), and cerebrovascular events (5.7%).
  
  
  CONCLUSIONS
  DDRTx in patients with DN has acceptable graft function and patient/graft survival over 10-year follow-up in our center and, therefore, we believe it should be encouraged.
authors.affiliation: Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmadabad 380016, Gujarat, India. drvivekkute@rediffmail.com
authors.forename: Vivek B
authors.initials: VB
authors.lastname: Kute
authors.forename: Suraj M
authors.initials: SM
authors.lastname: Godara
authors.forename: Pankaj R
authors.initials: PR
authors.lastname: Shah
authors.forename: Siddharth H
authors.initials: SH
authors.lastname: Jain
authors.forename: D P
authors.initials: DP
authors.lastname: Engineer
authors.forename: Himanshu V
authors.initials: HV
authors.lastname: Patel
authors.forename: Manoj R
authors.initials: MR
authors.lastname: Gumber
authors.forename: Bipin C
authors.initials: BC
authors.lastname: Munjappa
authors.forename: V V
authors.initials: VV
authors.lastname: Sainaresh
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Vanikar
authors.forename: Pranjal R
authors.initials: PR
authors.lastname: Modi
authors.forename: Veena R
authors.initials: VR
authors.lastname: Shah
authors.forename: Hargovind L
authors.initials: HL
authors.lastname: Trivedi
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D002102:Cadaver; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000097:blood; D003906:Developing Countries; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000209:etiology / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D013256:Steroids; D003404:Creatinine; D009173:Mycophenolic Acid; D001379:Azathioprine