Clinical transplantation · 2026
Five-Year Outcomes and Clinicopathological Correlations of Kidney Transplants From Deceased Donors With Diabetes.
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Colella-Santos Marina, Pepato Pedro Henrique, Proença Henrique Machado de Sousa, Moura Luiz Antonio Ribeiro de, Medina-Pestana José, Foresto Renato Demarchi, Requião-Moura Lúcio
Аннотация
BACKGROUND: Kidneys from deceased donors with diabetes mellitus are refused because diabetes is considered a marker of lower organ quality. We evaluated 5-year outcomes according to donor-recipient diabetes status and, secondarily, the prognostic value of pre-implantation histopathological findings among accepted diabetic donor kidneys.
METHODS: This retrospective single-center cohort study included adult recipients of deceased-donor kidney transplants performed between 2013 and 2017. Five-year kidney function and death-censored graft survival were compared according to donor diabetes status before and after 1:2 propensity score matching. A secondary exploratory analysis evaluated Banff chronicity parameters in pre-implantation pathology reports.
RESULTS: Among 3058 recipients, 244 received kidneys from diabetic donors. These donors were older, more frequently hypertensive, and had higher KDPI than non-diabetic donors. In unadjusted analyses, recipients of diabetic donor kidneys had lower eGFR and death-censored graft survival. After matching, eGFR from years 1 to 5, eGFR slope, and death-censored graft survival no longer differed between groups. Recipient diabetes did not significantly modify the association of donor diabetes with graft survival or longitudinal eGFR, although the D+/R+ subgroup was small (n = 39). Among 164 available pre-implantation biopsy reports, diabetes-related glomerular lesions were uncommon, chronic lesions were predominantly vascular and mild to moderate, and no Banff histological parameter independently predicted eGFR <30 mL/min/1.73 m2 or death-censored graft loss at 5 years.
CONCLUSIONS: After balancing baseline donor and recipient characteristics, donor diabetes was not associated with significantly lower 5-year kidney function or death-censored graft survival. In the secondary clinicopathological analysis, no individual Banff chronicity parameter independently predicted 5-year outcomes.
METHODS: This retrospective single-center cohort study included adult recipients of deceased-donor kidney transplants performed between 2013 and 2017. Five-year kidney function and death-censored graft survival were compared according to donor diabetes status before and after 1:2 propensity score matching. A secondary exploratory analysis evaluated Banff chronicity parameters in pre-implantation pathology reports.
RESULTS: Among 3058 recipients, 244 received kidneys from diabetic donors. These donors were older, more frequently hypertensive, and had higher KDPI than non-diabetic donors. In unadjusted analyses, recipients of diabetic donor kidneys had lower eGFR and death-censored graft survival. After matching, eGFR from years 1 to 5, eGFR slope, and death-censored graft survival no longer differed between groups. Recipient diabetes did not significantly modify the association of donor diabetes with graft survival or longitudinal eGFR, although the D+/R+ subgroup was small (n = 39). Among 164 available pre-implantation biopsy reports, diabetes-related glomerular lesions were uncommon, chronic lesions were predominantly vascular and mild to moderate, and no Banff histological parameter independently predicted eGFR <30 mL/min/1.73 m2 or death-censored graft loss at 5 years.
CONCLUSIONS: After balancing baseline donor and recipient characteristics, donor diabetes was not associated with significantly lower 5-year kidney function or death-censored graft survival. In the secondary clinicopathological analysis, no individual Banff chronicity parameter independently predicted 5-year outcomes.