Clinical outcome of type 2 diabetic patients after kidney transplantation: Systematic review

Abstract

AimTo conduct a systematic review to summarize the outcome of adult patients with history of type II DM after renal transplantation [RTx] in following category of patients: (1) type 2 DM; (2) type 2 DM vs Non-DM; (3) type 2 DM vs Dialysis; (4) Preemptive Kidney Transplant (prekTx) vs non prekTx. MethodMEDLINE, EMBASE, Renal transplant registries were searched for observational/cohort/case-control studies from 1980 to 2015. ResultsWe identified 10 studies reporting outcome of kidney transplantation in patients with type 2 DM [type 2 DM (2), type2 DM vs Non-DM (6), type 2 DM vs Dialysis (1), prekTx vs non-prekTx (1)]. One and five year graft survival ranged from 76% to 100% and 53% to 96% respectively. 8, 4, 8, and 2 studies showed 1, 3, 5 and 10 yr patient survival respectively. Recent study with type 2 DM patients showed at 10yrs, graft survival did not differ between Non-DM and type 2 DM but Non-DM patient survival was better (p<.001) than type 2 DM patients after RTx. At 5 yrs, patient survival ranged from 29% to 97%. Graft and patient survival did not differ between type 2 DM and Non-DM patients in three and two studies respectively. A study showed at 10 yrs, survival after RTx was significantly (p<.001) better than patients on dialysis. Preemptive transplant study reported lower adjusted graft failure and mortality risk for type 2 DM transplant recipients from living donors compared to deceased donors. ConclusionResults from these few single center studies demonstrate the need for multicenter rigorous studies to look at long term survival of type 2 diabetes patients after renal transplant.