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Five-Year Follow-up

David Shaffer, MD; Mary Ann Simpson, PhD; Peter N. Madras, MD; Anthony I. Sahyoun, MD; Patricia A. Conway, RN; Carole P. Davis, MS, RN; Anthony P. Monaco, MD

Arch Surg. 1995;130(3):283-288.

Abstract
Objective
To review our center's experience with kidney transplantation in diabetic recipients; specifically, to compare long-term (5-year) patient and graft survival rates between diabetic and nondiabetic recipients overall and according to donor source using cyclosporine-based immunosuppression.

Design
A retrospective review of all kidney transplants performed over the 7-year period from 1987 to 1993.

Setting
A large urban tertiary care referral center with a long history of kidney transplantation and care of the diabetic patient.

Patients
All patients receiving a kidney transplant, either alone or simultaneously with a pancreas transplant, were reviewed.

Main Outcome Measures
Actuarial patient and graft survival, serum creatinine levels, and causes of late graft loss.

Results
There was no significant difference in actuarial 5-year patient or kidney graft survival between diabetic and nondiabetic recipients overall or when analyzed by donor source. There was no significant difference in mean serum creatinine levels at 5 years between diabetic and nondiabetic recipients overall or between diabetic and nondiabetic cadaveric recipients. While chronic rejection was the major cause of late graft loss in non-diabetic recipients, death with a functioning graft, principally due to cardiovascular disease, was the major cause of graft loss in diabetic recipients.

Conclusions
With cyclosporine-based immunosuppression, diabetic kidney transplant recipients have 5-year patient and graft survival rates and allograft function comparable to nondiabetic recipients. Given the high mortality of diabetic patients receiving dialysis, kidney transplantation is the treatment of choice for end-stage diabetic renal disease.

(Arch Surg. 1995;130:283-288)

Author Affiliations
From the Division of Organ Transplantation, New England Deaconess Hospital and Harvard Medical School, Boston, Mass.

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