LONG-TERM OUTCOMES IN DIABETICS FOLLOWING CADAVERIC RENAL TRANSPLANTATION

Abstract

568 Diabetes mellitus accounts for 20% of renal transplants annually. We retrospectively analyzed the long-term outcomes of 308 diabetic cadaveric renal transplant patients transplanted between 1984-1994 to determine the incidence of vascular and musculoskeletal complications. Three separate eras (1984-1987, 1988-1990, 1991-1994) were analyzed because of changing immunosuppressive strategies. The length of follow-up varied from 3 to 13 years. 10 year data for patient survival in Type I vs Type II diabetics was 48% vs 20% (p=0.0001). Similarly, graft survival was 35% vs 8% (p=0.0001). Trends in the more recent years included an older age at transplantation(p<0.001), more patients with Type II DM (p<0.0001), increased pre-transplant coronary artery disease (CAD) screening (p<0.0001), a higher rate of revascularization prior to transplant (p<0.0001) and more cerebrovascular disease (p=0.014). Post-transplant, there were higher rates of peripheral vascular disease in patients transplanted in 1990-1994 (p=0.003). There was no difference in the incidence of cardiovascular, cerebrovascular or musculoskeletal events in the post-transplant period in the three eras. However, 10 years post-transplantation, 44% had cardiac disease, 46% had peripheral vascular disease and 38% had amputations. Pre-transplant cardiac disease appeared to result in poorer post-transplant survival course (p=0.07). Type II diabetics with CAD had a worse outcome(p=0.02). 173 graft failures occurred; the most common causes being death with a functioning graft (51%), chronic rejection (19%), and acute rejection(13%). The most common cause of death was coronary artery disease (29%), followed by infection (16%). In conclusion, recipients with Type II DM have a higher rate of pre-transplant cardiovascular risk factors and hence a not unexpected poorer outcome primarily due to death from CAD. This study emphasizes the importance of aggressive screening for cardiac disease pre-transplant. There is also a suggestion that a very active pancreas-kidney transplant program at this center has added to the changing demographics in this population.