In certain patients with diabetes-related kidney disease, performing a transplant before the need for dialysis arises seems to be advantageous.
Dr. Bryan N. Becker stated that, "preemptive transplantation remains an optimal form of kidney replacement therapy for individuals with diabetes when they receive a living donor kidney — or when they receive a simultaneous pancreas-kidney transplant, in the case of individuals with type 1 diabetes."
Becker, at the University of Wisconsin-Madison, and colleagues note in the Annals of Internal Medicine that reports show that the technique is effective when used before the onset of chronic dialysis. However, a number of details are lacking.
To investigate further, the researchers examined U.S. national data on more than 23,000 patients with type 1 and type 2 diabetes who received kidney transplants from living or deceased donor, or simultaneous pancreas-kidney transplantation.
In all, preemptive transplantations were received by 14.4 percent of patients with diabetes type 1 and 6.7 percent of patients with diabetes type 2.
After adjusting for factors including age, sex and race, preemptive transplantation was associated with a lower risk of dying in both type 1 and type 2 diabetics only when the transplant was from a living donor. For simultaneous pancreas-kidney recipients, benefit was seen only in those with type 1 diabetes.
The apparently reduced benefit from preemptive transplantation from deceased donors, compared to that seen in the early 1990s, deserves further study, the team concludes.
Annals of Internal Medicine, January 6, 2006.