Kidney transplantation in diabetic patients using cyclosporine. Five-year follow-up.

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.