Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Clin Transplant. 2020 Dec;34(12):e14115. doi: 10.1111/ctr.14115. Epub 2020 Nov 1.
The use of diabetic kidneys is increasing worldwide with better outcome than being on waitlist and possible reversal of diabetic changes in transplanted kidneys. But particular caution is warranted in diabetic donor-recipient combination. Total 1223 deceased donor kidney transplants were performed at our center between 2008 and 2018. 689 from non-diabetic donor (NDD) to non-diabetic recipient, 400 from non-diabetic donor to diabetic recipient, 97 from diabetic to non-diabetic recipient, and 32 from diabetic donor (DD) to diabetic recipient. The DD was older than NDDs (median age 48 vs 39 years, P < 0.0001). DD had higher BMI (35.6 vs 26.9, P < 0.0001), higher KDPI (74% vs 37%, P < 0.0001), and higher terminal creatinine (1.10 mg/dl vs 0.95 mg/dl, p 0.0046) than the NDD. Diabetes recipients were comparatively older (57 vs 54, P < 0.001). DD recipients had higher serum creatinine at 6 months (1.70 vs 1.50 mg/dl, p 0.00304) and 2 years post-transplant (1.70 vs 1.50 mg/dl P < 0.0002). DD recipients had more favorable end CPRA than NDD recipients (77.5% at 0% vs 67.4% at 0, P = 0.0074). Ten-year patient and graft survival was best in NDD-recipient pair and worse in DD-recipient pair. Diabetic donor kidneys to diabetic recipients have lower 1-, 3-, and 5-year graft survival.
全球范围内，使用糖尿病患者供体的肾脏进行移植的情况正在增加，其效果优于等待名单中的患者，且移植肾脏的糖尿病相关变化可能逆转。但是，在糖尿病供体-受者组合中需要特别谨慎。2008 年至 2018 年期间，我们中心共进行了 1223 例已故供体肾移植。其中，689 例来自非糖尿病供体（NDD）至非糖尿病受者，400 例来自 NDD 至糖尿病受者，97 例来自糖尿病供体至非糖尿病受者，32 例来自糖尿病供体（DD）至糖尿病受者。DD 比 NDD 年龄更大（中位数年龄 48 岁 vs 39 岁，P<0.0001）。DD 的 BMI（35.6 比 26.9，P<0.0001）、KDPI（74%比 37%，P<0.0001）和终末期肌酐（1.10 毫克/分升比 0.95 毫克/分升，P<0.0046）均高于 NDD。糖尿病受者相对年龄较大（57 岁 vs 54 岁，P<0.001）。DD 受者在移植后 6 个月（1.70 毫克/分升比 1.50 毫克/分升，P<0.00304）和 2 年时（1.70 毫克/分升比 1.50 毫克/分升，P<0.0002）的血清肌酐更高。DD 受者的终末期 CPRA 比 NDD 受者更有利（0%时为 77.5%，0 时为 67.4%，P=0.0074）。NDD-受者组的 10 年患者和移植物存活率最佳，而 DD-受者组的存活率最差。糖尿病供体肾脏至糖尿病受者的移植物 1、3 和 5 年存活率较低。
