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Kidney Transplant in Patients with Diabetic Nephropathy-related ESRD

Results are promising but rejection rate is higher with deceased donor transplants…. 

A study was done to investigate the survival rate and to determine factors that influence survival among diabetic patients who underwent transplantation at the Shiraz Namazi Hospital Transplant Center in Shiraz, Iran between 1999 and 2009. The study design was a historical cohort study, which examined the graft survival rate among 103 kidney transplant patients who had end-stage renal disease (ESRD) due to diabetic nephropathy. Of the 103 patients, 97 cases attended regular follow-up appointments. Thirteen of the ninety-seven cases (13.4%) had irreversible allograft rejection resulting in a return to dialysis or death. The mean age of the recipients was 47.69 while the mean age of the donors was 31.6 years; 74.5% of the recipients and 74.3% of the donors were male. In 61% of the cases, both the donor and the recipient were the same gender. In most cases, 85.4%, the blood group of the recipient and the donor was the same.

Although there was no significant relationship between survival rate and type of donor, the prevalence of rejection was much higher in deceased donor transplants (25.8%), whereas in living related and living unrelated transplants, the prevalence of rejection was 5% and 8.7%, respectively. Numerous studies have shown that there is no significant relationship between types of immunosuppressive drug administered and graft survival rate. A previous study showed that the age of the donor is one of the factors that influences allograft survival rate; this could be due to reduction of the number of functioning nephrons in older age. However, other studies, including this one, did not show a significant relationship between age of donor and survival rate.

According to the results of this study, there is no difference between allograft survival rates in diabetic and non-diabetic patients and thus, renal transplantation can be a promising therapeutic option for patients with ESRD from diabetic nephropathy.

Practice Pearls:
  • In most countries worldwide, diabetic nephropathy is the most common cause of kidney failure resulting in a need for dialysis
  • In the United States, more than 40% of the patient suffering with kidney failure are diabetic and this number is rising.
  • There is no difference between allograft survival rates in diabetic and non-diabetic patients and thus, renal transplantation can be a promising therapeutic option for patients with ESRD from diabetic nephropathy.

Rajaeefard A R, Almasi-Hashiani A, Hassanzade J, Salahi H. Graft survival rate following renal transplantation in diabetic patients. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2014 Jul 13];23:707-14.