Living Kidney Transplantation from Marginal Donors with Diabetes. Report of Prognosis and Outcomes of 5 Pairs of Recipients and Donors

Abstract

Introduction From the shortage of donor, marginally appropriate donors might be considered in order to extend the donor criteria. In Japan, living donor criteria of Japan Transplantation Society accepts marginal donors, who are strictly treated with diet control or oral anti-diabetes medication. Here we report prognoses and outcomes of five cases of donors and recipients after living kidney transplants from living donors, who had mild diabetes. Patients and Methods From Dec. 2007 to Nov. 2017, total of 51 living related kidney transplants had been done in our hospital, five of 51 donors had mild diabetes, treated with diet control or oral anti-diabetes medication. Renal function of the recipients and donors, and their outcomes and prognoses were investigated after the transplantation. Results Mean age of donors with controlled diabetes was 68.2 (62-76) yeas old. Donors with mild diabetes were relatively older than normal donors. They had untreated or under controlled diabetes at the first visit of our hospital, so they were required additional strict control and observation period for six months or more. Preoperative HbA1c and 24-hour urine protein of donors with diabetes were controlled within 6.0-6.3 % and 10-75mg/day. No pathological finding of diabetic nephropathy was observed in one-hour biopsies of grafts from diabetic donors. Mean observation period of recipients was 74.1 (53.9-89.8) months, in one case graft loss caused by chronic rejection had happened in 21.4 months after transplant. The other four of five recipients had stable renal function and their present sCr was 1.83 (1.32-2.53) mg/dl. Mean graft survival period of them was 60.4 (21.4-80.9) months. One of five donors died of advanced colon cancer and gallbladder cancer in 22 months after surgery, the other four of five donors were still alive and had stable renal function. Mean present sCr of alive donors was 1.00 (0.81-1.26) mg/dl. Discussion and conclusion Prognosis and outcome of renal transplant recipients and donors from marginal donor with mild diabetes were acceptable, as long as we had not deviated from the marginal donor criteria of JST.