Outcome of cadaver kidney transplantation in 23 patients with type 2 diabetes mellitus

Background. Type 2 diabetes mellitus (DM) is a growing cause of end-stage r enal failure worldwide. Yet, only a minority of type 2 diabetics are consid ered today for kidney transplantation (KT). The scarcity of data on the out come of such patients after KT prompted us to review our experience. Methods. Between 1 January 1983 and 30 June 1996, 23 patients with type 2 D M received a first cadaver KT at a mean age of 57 +/- 9 (41-73) years, afte r a dialysis period ranging from 5 to 72 (mean 25 +/- 18) months. Only nine patients had a history of coronary and/or peripheral vascular disease befo re KT. All were given cyclosporin- or tacrolimus-based immunosuppression. P ost-KT follow-up ranged from 4 to 181 (mean 70+/-38) months. Outcome analys is focused on the impact of cardiovascular complications. Results. Patient survival at 1, 5 and 8 years was 91, 83 and 76% respective ly. Death was due to infection in three patients and to a cardiovascular ev ent in two. The actuarial risk of coronary, cerebrovascular, peripheral vas cular, and any cardiovascular event after KT was 14, 13, 9 and 30%, at 1 ye ar, 20, 13, 50 and 58% at 5 years, and 20, 46, 66 and 72% at 8 years respec tively. Post-KT hospital readmissions averaged 10 days/patient-year and wer e mostly related to the management of peripheral vascular disease. Conclusion. KT is an excellent therapeutic option for selected patients wit h type 2 DM. Peripheral vascular disease is the leading cause of morbidity following KT. KT should be considered in type 2 diabetics with a low/medium cardiovascular risk.