Long-term graft and patient survival following renal transplantation in diabetic patients

Objective

To study long-term graft and patient survival following renal transplantation in diabetic and non-diabetic patients.

Material and methods

Over the time period 1985–99, 498 transplantations in 399 non-diabetic patients and 68 transplantations in 62 diabetic patients were performed. The groups were similar with respect to age and sex.

Results

The patient survival rates (diabetic versus non-diabetic patients) were 88% vs 91% (p=NS) at 1 year, 68% vs 73% (p=NS) at 5 years and 31% vs 52% (p<0.05) at 10 years. The graft survival rates (diabetic versus non-diabetic patients) were 72% vs 72% at 1 year, 52% vs 52% at 5 years and 27% vs 33% (p=NS) at 10 years. In the diabetic patients, mean haemoglobin (Hb)A_1c 2 years before and 2 years after the transplantation was 7.5±1.4 vs 8.2±1.6 mmol/l (p<0.05) and the mean blood pressure was 112±12 vs 107±9 mmHg (p<0.05). Of the diabetic patients, 55% were smokers. Among the diabetic patients, graft and patient survival were independent of smoking habits, blood pressure, HbA_1c and total cholesterol.

Conclusions

Graft survival was similar in diabetic and non-diabetic patients. For the first 5 years following renal transplantation, the patient survival rates in the two groups were similar. Thereafter, survival among diabetic patients was poor. Mean HbA_1c was relatively high, especially after the transplantation, and this may have contributed to the more rapid progression of cardiovascular disease seen in diabetic patients with nephropathy.

• Diabetes mellitus
• diabetic nephropathy
• end-stage renal disease
• renal transplantation
• survival
• graft survival
• cardiovascular diseases