Skip to main content

Advertisement

SpringerLink
Log in

Outcome of deceased donor renal transplantation in diabetic nephropathy: a single-center experience from a developing country

  • Nephrology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

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.

Materials and 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%).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Joshi SR, Parikh RM (2007) India-diabetes capital of the world: now heading towards hypertension. J Assoc Physicians India 55:323–324

    PubMed  Google Scholar 

  2. Modi GK, Jha V (2006) The incidence of end-stage renal disease in India: a population-based study. Kidney Int 70(12):2131–2133 (Epub 2006 Oct 25)

    PubMed  CAS  Google Scholar 

  3. 5 year cumulative annual report (2010) CKD registry of India: Indian society of nephrology online resources. Available from: http://www.ckdri.org

  4. Rajapurkar M, Dabhi M (2010) Burden of disease-prevalence and incidence of renal disease in India. Clin Nephrol 74(suppl 1):S9–S12

    PubMed  Google Scholar 

  5. Friedman EA (2002) Diabetic nephropathy: improving prognosis. Saudi J Kidney Dis Transpl 13(3):281–310

    PubMed  Google Scholar 

  6. Acharya VN (2011) Diabetic and hypertensive nephropathy in India. J Assoc Physicians India 59:143

    Google Scholar 

  7. Chugh KS (2009) Five decades of Indian nephrology: a personal journey: American. J Kidney Dis 54:753–763 (Epub 2 Sept 2009)

    Google Scholar 

  8. Feroz A, Dabhi M, Gumber M et al (2007) Cadaveric renal transplantation: our experience at the Institute of kidney diseases & research centre, Institute of transplantation sciences, Ahmedabad. Transpl Proc 39:721–722

    Article  CAS  Google Scholar 

  9. Ma H, Gong Y, Liu YY, Song J, Tian HM, Chen T et al. (2001) Prevalence of diabetes and prediabetes mellitus in the first-degree relatives of patients with type 2 diabetes in Chengdu (Article in Chinese). Sichuan Da Xue Xue Bao Yi Xue Ban 42:264–268

    Google Scholar 

  10. Benhamou PY, Marwah T, Balducci F et al (1992) Classification of diabetes in patients with end-stage renal disease: validation of clinical criteria according to fasting plasma C-peptide. Clin Nephrol 38:239–244

    PubMed  CAS  Google Scholar 

  11. American diabetes association expert committee report of the expert committee on the diagnosis and classification of diabetes mellitus (1997) Diabetes Care 20:1183–1197

    Google Scholar 

  12. Mieghem AV, Fonck C, Coosemans W et al. (2001) Outcome of cadaver kidney transplantation in 23 patients with type 2 diabetes mellitus. Nephrol Dial Transpl 16(8):1686–1691

    Google Scholar 

  13. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease (2007) Am J Kidney Dis 49(2 suppl 2):S12–S154

    Google Scholar 

  14. Biesenbach G, Bodlaj G, Pieringer H, Sedlak M (2011) Clinical versus histological diagnosis of diabetic nephropathy–is renal biopsy required in type 2 diabetic patients with renal disease? QJM. 18 April 2011 (Epub ahead of print) PMID: 21504987

  15. Sharma AM, Weir MR (2011) The role of angiotensin receptor blockers in diabetic nephropathy. Postgrad Med 123(3):109–121

    PubMed  Google Scholar 

  16. Tervaert TW, Mooyaart AL, Amann K, Cohen AH, Cook HT, Drachenberg CB et al. (2010) Pathologic classification of diabetic nephropathy. J Am Soc Nephrol 21(4):556

    Google Scholar 

  17. Luan FL, Samaniego M (2010) Transplantation in diabetic kidney failure patients: modalities, outcomes, and clinical management. Semin Dial 23(2):198–205 (Epub 2010 Mar 30)

    Article  PubMed  Google Scholar 

  18. Reilly JB, Berns JS (2010) Selection and dosing of medications for management of diabetes in patients with advanced kidney disease. Semin Dial 23(2):163–168

    Article  PubMed  Google Scholar 

  19. Wolfe RA, Ashby VB, Milford EL et al (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341(23):1725–1730

    Article  PubMed  CAS  Google Scholar 

  20. Locatelli F, Pozzoni P, Del Vecchio L (2004) Renal replacement therapy in patients with diabetes and endstage renal disease. J Am Soc Nephrol 15(suppl 1):S25–S29

    Article  PubMed  Google Scholar 

  21. Cosio FG, Hickson LJ, Griffin MD et al (2008) Patient survival and cardiovascular risk after kidney transplantation: the challenge of diabetes. Am J Transpl 8(3):593–599

    Article  CAS  Google Scholar 

  22. Witczak BJ, Hartmann A, Jenssen T et al (2006) Routine coronary angiography in diabetic nephropathy patients before transplantation. Am J Transpl 6(10):2403–2408

    Article  CAS  Google Scholar 

  23. Ramanathan V, Goral S, Tanriover B et al (2005) Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation. Transplantation 79(10):1453–1458

    Article  PubMed  Google Scholar 

  24. Welsh RC, Cockfield SM, Campbell P, Hervas-Malo M, Gyenes G, Dzavik V (2011) Cardiovascular assessment of diabetic end-stage renal disease patients before renal transplantation. Transplantation 91:213–218

    Google Scholar 

  25. Gang S, Dabhi M, Rajapurkar MM (2007) Ischaemia imaging in type 2 diabetic kidney transplant candidates–is coronary angiography essential? Nephrol Dial Transpl 22:2334–2338 (Epub 5 June 2007)

    Google Scholar 

  26. Friedman EA (1999) Advanced glycation end-products in diabetic nephropathy. Nephrol Dial Transpl 14(suppl 3):1–9

    Article  CAS  Google Scholar 

  27. Manske CL, Wang Y, Rector T et al (1992) Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure. Lancet 340(8826):998–1002

    Article  PubMed  CAS  Google Scholar 

  28. Evans RW, Manninen DL, Garrison LP Jr et al (1985) The quality of life of patients with end-stage renal disease. N Engl J Med 312:553–559

    Article  PubMed  CAS  Google Scholar 

  29. Goldfarb-Rumyantzev A, Hurdle JF, Scandling J et al (2005) Duration of end-stage renal disease and kidney transplant outcome. Nephrol Dial Transpl 20(1):167–175

    Article  Google Scholar 

  30. Shoskes DA, Cecka JM (1998) Deleterious effects of delayed graft function in cadaveric renal transplant recipients independent of acute rejection. Transplantation 66(12):1697–1701

    Article  PubMed  CAS  Google Scholar 

  31. Parekh J, Bostrom A, Feng S (2010) Diabetes mellitus: a risk factor for delayed graft function after deceased donor kidney transplantation. Am J Transpl 10(2):298–303

    Article  CAS  Google Scholar 

  32. Rao PS, Ojo A (2009) The alphabet soup of kidney transplantation: SCD, DCD, ECD-fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol 4(11):1827–1831 (Epub 2009 Sep 24)

    Article  PubMed  Google Scholar 

  33. Jha V, Chugh KS (2002) Post-transplant infections in the tropical countries. Artif Organs 26(9):770–777

    Article  PubMed  Google Scholar 

  34. Jha V, Chugh S, Chugh KS (2000) Infections in dialysis and transplant patients in tropical countries. Kidney Int 57(suppl 74):S85–S93

    Article  Google Scholar 

  35. Kher V (2002) End-stage renal disease in developing countries. Kidney Int 62(1):350–362

    Article  PubMed  Google Scholar 

  36. Sakhuja V, Jha V, Varma PP et al (1996) The high incidence of tuberculosis among renal transplant recipients in India. Transplantation 61(2):211–215

    Article  PubMed  CAS  Google Scholar 

  37. Jha V (2010) Post-transplant infections: an ounce of prevention. Indian J Nephrol 20(4):171–178

    Article  PubMed  CAS  Google Scholar 

  38. Shah BR, Hux JE (2003) Quantifying the risk of infectious diseases from people with diabetes. Diabetes Care 26(2):510–513

    Article  PubMed  Google Scholar 

  39. John GT, Shankar V, Abraham AM, Mukundan U, Thomas PP, Jacob CK (2001) Risk factors for post-transplant tuberculosis. Kidney Int 60(3):1148–1153

    Google Scholar 

  40. Bhowmik D, Dinda AK, Khilnani GC, Mahajan S, Gupta S, Agarwal SK et al (2002) Pulmonary mucormycosis in a diabetic renal transplant patient. Indian J Chest Dis Allied Sci 44(44):275–277

    PubMed  CAS  Google Scholar 

  41. Agrawal V, Gupta RK, Jain M (2005) Invasive fungal infections in renal allograft recipients. Indian J Pathol Microbiol 48(4):448–452

    PubMed  Google Scholar 

  42. Singh N, Aguado JM, Bonatti H, Forrest G, Gupta KL, Safdar N et al. (2009) Zygomycosis in solid organ transplant recipients: a prospective, matched case-control study to assess risks for disease and outcome. J Infect Dis 200(6):1002–1011

    Google Scholar 

  43. Abraham G, John GT, Shroff S et al (2010) Evolution of renal transplantation in India over the last four decades. NDT Plus 3(2):203–207

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Priya shah, Sengunthar Shobhanarani, and Jyotsna suthar, who contributed to data collection and statistical analysis.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmadabad, 380016, Gujarat, India

    Vivek B. Kute, Suraj M. Godara, Pankaj R. Shah, Siddharth H. Jain, D. P. Engineer, Himanshu V. Patel, Manoj R. Gumber, Bipin C. Munjappa, V. V. Sainaresh & Hargovind L. Trivedi

  2. Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmadabad, 380016, Gujarat, India

    Aruna V. Vanikar

  3. Department of Urology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmadabad, 380016, Gujarat, India

    Pranjal R. Modi

  4. Department of Anathesia and Critical Care, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmadabad, 380016, Gujarat, India

    Veena R. Shah

Authors
  1. Vivek B. Kute
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suraj M. Godara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pankaj R. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Siddharth H. Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. P. Engineer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Himanshu V. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Manoj R. Gumber
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bipin C. Munjappa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. V. V. Sainaresh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Aruna V. Vanikar
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Pranjal R. Modi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Veena R. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hargovind L. Trivedi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vivek B. Kute.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kute, V.B., Godara, S.M., Shah, P.R. et al. Outcome of deceased donor renal transplantation in diabetic nephropathy: a single-center experience from a developing country. Int Urol Nephrol 44, 269–274 (2012). https://doi.org/10.1007/s11255-011-0040-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-011-0040-9

Keywords

Search

Navigation