SIMILAR TREATMENT SUCCESS RATE AFTER RENAL-TRANSPLANTATION IN DIABETIC AND NONDIABETIC PATIENTS DUE TO IMPROVED SHORT-TERM AND LONG-TERM DIABETIC PATIENT SURVIVAL

In the early era of transplantation, it was common practice to exclude diabetic patients since the outcome in such cases was usually poor. A t our center in Malmo, Sweden, diabetic nephropathy was never regarded as a contraindication. During the 22-year period from 1972 to 1993, 2 23 renal allografts were transplanted in 189 uremic diabetics, represe nting 24 % of all renal transplant recipients (n = 788). The two subgr oups - patients with and without diabetes did not differ significantly in graft survival rates for the 22-year period, which was characteriz ed by a successive improvement in the success rate that was especially striking in the diabetic nephropathy subgroup. Among transplantations performed before 1988, the overall patient survival rate was signific antly lower in the diabetic subgroup than in the remainder. After 1988 (when a series of new procedures had been adopted), the patient survi val rate in the diabetic subgroup was similar to that in the nondiabet ic subgroup, a similarity that persisted for at least 5 years. The 1st year post-transplant mortality rate was reduced in diabetic patients from 24 % before 1988 to 0 % in those transplanted after 1988. In the 22-year period as a whole, cardiovascular or cerebrovascular events we re the most common cause of death in both subgroups; the risk of cardi ovascular or cerebrovascular death was reduced after 1988, and the rat es were similar in both subgroups. The improved success rate of renal transplantation in patients with diabetic nephropathy supports continu ation of the renal transplant program, which is based on careful manag ement of the early stages of the disease.