Kidney transplantation in diabetic patients using cyclosporine. Five-year follow-up
D. Shaffer, M. A. Simpson, P. N. Madras, A. I. Sahyoun, P. A. Conway, C. P. Davis and A. P. Monaco
Division of Organ Transplantation, New England Deaconess Hospital, Boston, Mass.
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 nondiabetic
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.
