Renal transplantation for Type II diabetic patients compared with Type I diabetic patients and patients over 50 years old: a single-center experience

Introduction. Transplantation of renal allografts for Type II diabetic pati ents has become increasingly common. Like Type I diabrtics and patients ove r age 50, Type II diabetics are in a high-risk category for renal transplan tation. Some investigators argue that the scarce resources of the valuable donor pool should not be allocated to these high-risk, older individuals wi th end-stage renal disease (ESRD) who often have significant comorbidity. W e studied the outcome of renal transplantation for 90 Type II diabetics and compared it with the outcome for Type I diabetics and patients over age 50 with other primary diseases. Methods. We conducted a retrospective review of data on all renal transplan ts performed at the University of Minnesota since September 1984 for Type I I diabetics. We analyzed both patient and graft survival rates and compared them with the outcome for Type I diabetics and separately for all nondiabe tics over age 50, We grouped recipients by donor source (living vs. cadaver ) and age at transplant (50 vs. >50). We studied reasons for graft loss, pa tient death, pre-operative morbidity, and post-operative complications. Results. We found that recipient age and donor sourer did not affect outcom e. Overall 5-yr patient survival for Type II diabetics was 61%; graft survi val, 53%. Type II diabetics had significantly worse patient and graft survi val than Type I diabetics and than nondiabetics over age 50, However, death -censored graft survival was not different between these groups, suggesting little difference in immunologic graft loss. Conclusions. Renal transplantation is a relatively safe, viable option for Type II diabetics with ESRD and significant comorbidity. Although their ove rall graft survival is less than for Type I diabetics and for nondiabetics over age 50, the immunologic graft failure rate is the same in all three gr oups.