Kidney transplantation in diabetic renal failure. A clinical and physiological study.

The results of kidney transplantation in 100 consecutive diabetic patients, transplanted between December 1972 and June 1982, are presented. Cardiac function was studied in parallel using non-invasive methods (phonocardiography, apexcardiography, carotid pulse tracing and M-mode echocardiography) in a subsample of the patients before transplant (n = 27) and repeatedly after successful transplant (n = 17). The study period was divided into two parts: 1972-1976 (era I, 21 patients) and 1977-1982 (era II, 79 patients). A high percentage of living related donors (LRD) characterised era II. A group of 168 non-diabetic patients, aged 20-54 years, served as controls to the 72 juvenile-onset diabetics during era II. During era II both patient (PS) and graft (GS) survival had improved considerably compared to era I. Actuarial PS was comparable to non-diabetic controls in the three years following transplant in both recipients of LRD (82% vs 97%) and cadaveric donor (CD) kidneys (70% vs 77%) and, in addition, in LRD recipients for five years (79% vs 88%). In diabetic LRD recipients, actuarial GS was similar to controls until five years after transplant (68% vs 72%) but was inferior in CD recipients at three years (37% vs 56%, p less than 0.05). The overall GS in CD transplantation was influenced positively by a high success rate in retransplantation. Cardiac mortality was low after successful transplant but increased substantially after graft failure. Peripheral vascular insufficiency was the dominating posttransplant complication and primary cytomegalo viral infections were common also. Hypertension was a constant finding pretransplant and posed a problem also at posttransplant, despite good graft function. Rejection accounted for the majority of primary graft failures. Stable glomerular filtration rate prevailed after successful transplant in LRD recipients. Hospital stay during the first three years following successful transplant in LRD recipients averaged one month per year, about twice as long as for controls. Rehabilitation was good, however, in these diabetics. The left ventricular (LV) function was severely compromised pretransplant, with impaired diastolic function and a pronounced LV hypertrophy as the most prominent features. The LV systolic function was well preserved in relation to end-systolic wall stress. The haemodynamic situation was that of a hyperdynamic circulation. Successful transplantation was associated with a gradual reversal of hypertrophy, normalisation of end-systolic wall stress and a raise in myocardial contractility.(ABSTRACT TRUNCATED AT 400 WORDS)