Kidneys From Donors With Diabetes Linked to Worse Outcomes

PHILADELPHIA — Kidneys from donors with diabetes are associated with an increased risk for graft loss and death compared with kidneys from donors without diabetes, especially in recipients with diabetes, investigators reported at the 2015 American Transplant Congress.

Using United Network for Organ Sharing registry data, Deirdre Sawinski, MD, and colleagues at the University of Pennsylvania in Philadelphia compared outcomes between pairs of recipients receiving a kidney from the same donor. 

The researchers stratified subjects by the diabetes status of both donor and recipient. Among pairs in which one recipient had diabetes and the mate recipient did not, 1,539 received kidneys from donors with diabetes and 21,459 received kidneys from donors without diabetes.

Compared with diabetic recipients of kidneys from donors with diabetes, nondiabetic recipients of kidneys from donors with diabetes had a significant 19% decreased risk for graft loss and a 35% decreased risk for death. 

Additionally, results showed that diabetic recipients of a kidney from a donor without diabetes had a 49% increased risk for graft loss and 1.9 times increased risk for death compared with nondiabetic recipients of kidneys from donors without diabetes.

The study found no difference in the risk for graft loss when diabetic recipients of kidneys from donors without diabetes were compared with nondiabetic recipients of kidneys from donors with diabetes.

“Given the overall shortage of kidneys, these organs [from diabetics] should not be discarded; however, they should be allocated with caution,” Sawinski told Renal & Urology News. “In particular I would recommend against their use in younger patients. Patients should be counseled about the increased risk of allograft loss associated with these organs.”

Asked whether diabetic transplant candidates should be advised to wait for a donor without diabetes, Sawinski said this would depend on the patient. Clinicians need to consider that patients with diabetes are at increased risk for death on dialysis, especially those with other comorbid conditions, and take into account wait times in the patient’s region. 

“So I would argue that in high-risk patients (those with multiple medical comorbidities) or for those in long-wait areas, it still might be advantageous to consider a diabetic donor kidney over waiting on dialysis,” Sawinski said.

In a separate study presented at the meeting, Canadian researchers reported that transplanting kidneys from selected deceased donors with diabetes into recipients with diabetes does not worsen outcomes beyond the effect of recipient diabetes alone.

Investigators at Toronto General Hospital studied a cohort of 67,815 kidney transplant recipients, of whom 1,404 with diabetes who received a kidney from a diabetic deceased donor. Compared with recipients who did not have diabetes, recipients with diabetes who received a kidney from a diabetic deceased donor did not have a significantly increased risk for total or death-censored graft failure, total mortality or death with a functioning graft. 

Nondiabetic recipients who received a kidney from a donor without diabetes, however, had a significantly increased risk for total mortality and death with a functioning graft compared with recipients with diabetes.

References

1. Cohen J et al. 44 – National Outcomes of Kidney Tranplantation from Diabetic Donors: A Mate-Kidney Analysis.
2. Rajan T et al. 40 – Does a History of Diabetes in Deceased Donors Modify the Outcomes of Kidney Transplant Recipients With Diabetes? Both presented at: American Transplant Congress 2015; May 2-6, 2015; Philadelphia.

This article originally appeared on Renal and Urology News