5-year survival of diabetes, non-diabetes patients after kidney transplant now nearly equal

The five-year survival of diabetic kidney transplant patients is now comparable to the five-year survival of nondiabetic kidney recipients, according to a new Mayo Clinic study published online in Kidney International.

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 researchers said. 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, according to the researchers.

A Mayo Clinic research team led by Fernando Cosio, MD, 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 in the general population has improved in recent years. Post-transplant, patients with diabetes experienced a significant decline in major 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 researchers said. 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.”