Post Kidney Transplant Advances Boost Diabetes Survival

Five-year survival rates after kidney transplant for patients who have diabetes mellitus (DM) and those who do not are now nearly equal because of significant advances in post-transplant management, according to a new study.

“There is no doubt that care for diabetes-weight control, glucose control, and blood pressure control-really pays off,” said senior author Fernando Cosio, MD, Medical Director of Kidney and Pancreas Transplantation at the Mayo Clinic in Rochester, Minnesota. “Diabetic patients who undergo kidney transplantation can expect outcomes equally as successful as nondiabetics, provided they are diligent in their management of blood pressure, glucose, healthy weight, and other factors that influence their kidney function and overall well-being.”

DM has been the “bane of transplantation for a long time,” said Dr Cosio, “because individuals who come to us with diabetes before transplant have more than double the chance of dying following transplantation compared to those without diabetes. It has been difficult to achieve success in diabetes patients because of the very high mortality.”

Dr Cosio stated that DM has such profound consequences on patients before they go to transplant that survival had not improved to the level of those without DM.

“It became apparent to me that the difference in survival was narrowing over time,” compared with the large survival difference in the 1990s, he said. The survival of patients with DM in the general population has improved in recent years, he noted.

Dr Cosio and colleagues analyzed the experiences of nearly 1700 kidney recipients, including more than 400 who had DM before transplant, between 1996 and 2007. Compared with patients who did not have DM, the 5-year mortality was significantly increased because of higher cardiovascular-related, infection-related, and malignancy-related deaths in those with DM. However, 5-year mortality in patients with DM significantly declined over time, narrowing the mortality difference between patients with and those without DM and, in more recent years, largely eliminating it.

“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,” Dr Cosio said.

The decline in mortality resulting from DM did not relate to the patients’ reduced pretransplant risk profile, and it was independent of post-transplant variables. The use of cardioprotective medications and glycemic control improved over time post-transplant. In addition, graft function and serum albumin significantly improved over time, and these parameters related to better survival.

“Thus, survival of kidney recipients with diabetes mellitus has improved markedly since 1996, likely reflecting, at least in part, enhanced post-transplant management and outcomes,” said Dr Cosio.

The data are “interesting and exciting. Heart disease has declined by almost half-acute heart attacks and deaths from heart disease. The risk of infections is now the same in diabetics and nondiabetics,” he stated.

“It doesn’t matter if you are 20, 50, or 80 years old with diabetes,” Dr Cosio said. “Enhanced post-transplant management improves patient outcomes.”

The researchers published their results in the April 2, 2014 issue of Kidney International.