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Outcome of renal transplantation in patients with diabetic nephropathy—a single-center experience

  • Nephrology – Original Paper
  • Published:
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Abstract

Background

Type 2 diabetes mellitus (DM) is the commonest cause of end-stage renal disease (ESRD) worldwide. Data scarcity on renal transplantation (RTx) outcome in diabetic nephropathy (DN) prompted us to review our experience. This retrospective single-center, 5-year study was undertaken to evaluate patient and graft survival and function, evaluated by serum creatinine (SCr), rejection episodes, and mortality in patients.

Patients and methods

One hundred type 2 DM-ESRD patients underwent RTx [80 living-related (LRD), 20 deceased donor (DD)] at our center following cardiac fitness of recipient. Post-transplant immunosuppression consisted of calcineurin inhibitor–based regimen. The mean donor age in the LRD group was 40.6 years and 52 years in the DD group. Male recipients constituted 95% in the LRD and 65% in the DD group.

Results

Over a mean follow-up of 2.47 years, 1- and 5-year patient/graft survival in LRDRTx was 85.1%/95.9% and 82.6%/95.9%, respectively, and mean SCr (in mg/dl) at 1 and 5 years was 1.38 and 1.58 mg/dl, respectively, with 20% of cases developing acute rejection (AR) episodes. Fifteen percent of patients died, mainly due to infections, and 1.3% died of coronary artery disease (CAD). In DDRTx, over a mean follow-up of 3.17 years, 1- and 4-year patient/graft survival was 72%/89.7% and 54%/89.7%, respectively; mean SCr at 1 and 4 years was 1.40 and 1.75 mg/dl, respectively, with 20% of cases developing AR episodes. Totally, 30% of patients were lost, mainly due to infections, and 10% of patients died from cerebrovascular events.

Conclusion

In our center, in patients with RTx for type 2 DM diabetic nephropathy, the 4- and 5-year patient and graft survival rates and graft function can be considered acceptable. The results are better in LRDRTx than in DDRTx patients.

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Abbreviations

AR:

Acute rejection

AZA:

Azathioprine

CAD:

Coronary artery disease

CMV:

Cytomegalovirus

CNI:

Calcineurin inhibitors

CVA:

Cerebrovascular accidents

CVD:

Cardiovascular diseases

DD:

Deceased donor

DM:

Diabetes mellitus

DN:

Diabetic nephropathy

ESRD:

End-stage renal disease

LRD:

Living-related

MMF:

Mycophenolate mofetil

MP:

Methylprednisolone

r-ATG:

Rabbit-anti-thymocyte globulin

RTx:

Renal transplantation

SCr:

Serum creatinine

TMP/SMX:

Trimethoprim/sulfamethaxazole

UTI:

Urinary tract infections

References

  1. International Diabetes Federation (IDF) (2009) Diabetes atlas, 4th edn. http://shop.idf.org/catalog/

  2. Premlatha G, Shanthi Rani CS, Deepa E et al. (2000) Prevalence of diabetic complications in south Indians. Novo Nordisk, Diabetic Update 59–62

  3. Victoria Rugg International Diabetes Federation and the International Society of Nephrology (2003) Diabetes and kidney disease: time to Act. http://www.isn-online.org/isn/society/publications/isn_20119.html

  4. 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. PMID: 17063176

    PubMed  CAS  Google Scholar 

  5. Tobin GS, Tanenbaum ND, Brennanat DC et al (2009) Renal transplantation in diabetic nephropathy. http://www.uptodate.com/patients/content/topic

  6. 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 

  7. 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 

  8. Davis CL, Delmonico FL (2005) Living-donor kidney transplantation: a review of the current practices for the live donor. J Am Soc Nephrol 16(7):2098–2110

    Article  PubMed  Google Scholar 

  9. Glannon W (2008) Underestimating the risk in living kidney donation. J Med Ethics 34(3):127–128

    Article  PubMed  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

  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 Transplant 16(8):1686–1691

    Article  PubMed  CAS  Google Scholar 

  13. 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 

  14. Racusen LC, Colvin RB, Solez K et al (2003) Antibody-mediated rejection criteria–an addition to the Banff’97 classification of renal allograft rejection. Am J Transplant 3(6):708–714

    Article  PubMed  Google Scholar 

  15. Solez K, Colvin RB, Racusen LC et al (2007) Banff’05 meeting report: differential diagnosis of chronic allograft injury and elimination of chronic allograft nephropathy (‘CAN’). Am J Transplant 7(3):518–526

    Article  PubMed  CAS  Google Scholar 

  16. 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 

  17. Laupacis A, Keown P, Pus N et al (1996) A study of the quality of life and cost-utility of renal transplantation. Kidney Int 50:235–242

    Article  PubMed  CAS  Google Scholar 

  18. 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 

  19. Atkins RC, Zimmet P (2010) Diabetic kidney disease: act now or pay later. Kidney Int 77(5):375–377

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. Khauli RB, Steinmuller DR, Novick AC et al (1986) A critical look at survival of diabetics with end-stage renal disease. Transplantation versus dialysis therapy. Transplantation 41(5):598–602

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  24. 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 

  25. 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 

  26. International Diabetes Federation (IDF) (2006) Diabetes atlas, 3rd edn. http://www.diabetesatlas.org/

  27. Valera B, Gentil MA, Cabello V et al (2006) Epidemiology of urinary infections in renal transplant recipients. Transplant Proc 38(8):2414–2415

    Article  PubMed  CAS  Google Scholar 

  28. Alangaden GJ, Thyagarajan R, Gruber SA et al (2006) Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant 20(4):401–409

    Article  PubMed  Google Scholar 

  29. Naqvi SA (2002) Immunosuppression strategies in developing countries. Transplant Proc 34(6):2083–2084

    Article  PubMed  CAS  Google Scholar 

  30. Masri MA, Haberal M, Rizvi M et al (2004) The pharmacokinetic of Equoral vs Neoral in stable renal transplant patients: a multi- national multi-center study. Transplant Proc 36:80

    Article  PubMed  CAS  Google Scholar 

  31. Bittar J, Cepeda P, de la Fuente J et al (2006) Renal transplantation in diabetic patients. Transplant Proc 38(3):895–898

    Article  PubMed  CAS  Google Scholar 

  32. Kronson JW, Gillingham KJ, Sutherland DE, Matas AJ (2000) Renal transplantation for type II diabetic patients compared with type I diabetic patients and patients over 50 years old: a single-center experience. Clin Transplant 14(3):226–234

    Article  PubMed  CAS  Google Scholar 

  33. Boucek P, Saudek F, Pokorna E et al (2002) Kidney transplantation in type 2 diabetic patients: a comparison with matched non-diabetic subjects. Nephrol Dial Transplant 17(9):1678–1683

    Article  PubMed  Google Scholar 

  34. Hirschl MM, Heinz G, Sunder-Plassmann G, Derfler K (1992) Renal replacement therapy in type 2 diabetic patients: 10 years’ experience. Am J Kidney Dis 20(6):564–568

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  36. 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 

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

    Article  PubMed  CAS  Google Scholar 

  38. 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 

  39. Keith DS, Demattos A, Golconda M et al (2004) Effect of donor recipient age match on survival after first deceased donor renal transplantation. J Am Soc Nephrol 15(4):1086–1091

    Article  PubMed  Google Scholar 

  40. Jha V, Chugh KS (2002) Posttransplant infections in the tropical countries. Artif Organs 26(9):770–777

    Article  PubMed  Google Scholar 

  41. 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 

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

    Article  PubMed  Google Scholar 

  43. 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 

  44. John GT (2003) Infections after renal transplantation in India. Indian J Nephrol 13:14–19

    Google Scholar 

  45. 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 

  46. Ram R, Dakshina Murty KV, Prasad N (2005) Time table of infections after renal transplantation–South Indian experience. Indian J Nephrol 15: Supple2:S14–S21

    Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujrat, India

    Vivek B. Kute, Hargovind L. Trivedi, Pankaj R. Shah, Kamal R. Goplani, Manoj R. Gumber, Himanshu V. Patel & Suraj M. Godara

  2. Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, IKDRC-ITS, Ahmedabad, Gujrat, India

    Aruna V. Vanikar

  3. Department of Urology and Transplantation surgery, IKDRC-ITS, Ahmedabad, Gujrat, India

    Pranjal R. Modi

  4. Department of Anesthesia and Critical care, IKDRC-ITS, Ahmedabad, Gujrat, India

    Veena R. Shah

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  1. Vivek B. Kute
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  2. Aruna V. Vanikar
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  3. Hargovind L. Trivedi
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Correspondence to Vivek B. Kute.

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Kute, V.B., Vanikar, A.V., Trivedi, H.L. et al. Outcome of renal transplantation in patients with diabetic nephropathy—a single-center experience. Int Urol Nephrol 43, 535–541 (2011). https://doi.org/10.1007/s11255-010-9852-2

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