Mayo Clinic researchers have discovered that the five-year survival of diabetic kidney transplant patients is now on par with the five-year survival of nondiabetic kidney recipients.
These new findings are published on the Kidney International website and will also be printed in a future issue of the journal.
The study findings represent significant improvements in the management of kidney transplant patients who have diabetes and pre-transplant consequences of diabetes such as heart disease and high blood pressure. The study also suggests that improvements in patient management post-transplant have resulted in significant declines in subsequent cardiac events and a reduction in infections. Prior to 2004, the five-year mortality rate of diabetic kidney transplant patients was more than double that of nondiabetic kidney recipients.
To arrive at these latest findings, a Mayo Clinic research team led by Fernando Cosio, M.D., medical director of kidney and pancreas transplantation, analyzed the experiences of 1,688 kidney recipients, including 413 with diabetes prior to transplant between 1996 and 2007.
The survival of patients with diabetes mellitus in the general population has improved in recent years. Post-transplant, patients with diabetes experienced a significant decline in major fatal/nonfatal cardiac events and deaths from infections over time. In contrast, neither cardiac events nor overall mortality declined in recipients who did not have diabetes. The decline in mortality due to diabetes did not relate to a reduced pre-transplant risk profile and was independent of post-transplant variables. The use of cardioprotective medications and glycemic control improved over time post-transplant. Furthermore, graft function and serum albumin significantly improved over time, and these parameters related to better survival.
"We were really encouraged to see this gap improve so dramatically," says Dr. Cosio. "Diabetic patients who undergo kidney transplantation can expect outcomes equally as successful as nondiabetics, provided that they are diligent in their management of blood pressure, glucose, healthy weight, and other factors that influence their kidney function and overall well-being."
The Mayo Clinic research team also included Mira Keddis, M.D., Nephrology; Mireille El Ters, M.D.; Emilio Rodrigo, M.D., Ph.D.; Patrick Dean, M.D., Transplantation Surgery; Mariana Wohlfahrtova, M.D.; Yogish Kudva, M.B.B.S., Endocrinology; Elizabeth Lorenz, M.D., Nephrology and Hypertension.
More than 120,000 people are waiting for organ transplant in the United States. Nearly 2,000 of those are children. Every 10 minutes another name is added to the national waiting list. An average of 18 people die each day in the United States waiting for transplants that can't take place because of the shortage of donated organs.
- Mira T Keddis, Mireille El Ters, Emilio Rodrigo, Patrick Dean, Mariana Wohlfahrtova, Yogish C Kudva, Elizabeth C Lorenz, Fernando G Cosio. Enhanced posttransplant management of patients with diabetes improves patient outcomes. Kidney International, 2014; DOI: 10.1038/ki.2014.70
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