Abstract
BackgroundTransplantation with a diabetic donor kidney may have some benefits compared to remaining on the waitlist for selected patients. However, we found that some kidney transplant recipients have ongoing donor-transmitted diabetic kidney disease (DT-DKD) despite fair blood sugar control. This study aimed to survey the incidence and clinical pattern of DT-DKD in kidney transplant recipients.MethodsWe retrospectively reviewed the medical records of kidney transplantations in our hospital. We found 357 kidney transplantations from February 2006 to April 2018. Among these, 23 (6.4%) diabetic donor kidney transplantations were done in the study period.ResultsAmong the 23 recipients, 6 (26.1%) displayed biopsy-proven DKD. Recipients with biopsy-proven DKD had longer dialysis vintage, higher proteinuria amount, lower last estimated glomerular filtration rate (eGFR), and a more rapid decline in the eGFR. The median fasting blood sugar level in the biopsy-proven DKD group was unexpectedly lower than the non-DKD group. Most of the pre-implantation frozen sections in biopsy-proven DKD group showed diabetic lesions worse than diabetic nephropathy (DN) class IIa. In the biopsy-proven DKD group, 5 recipients had no history of diabetes before or after transplantation. Among the 23 recipients, 5 (21.7%) were diagnosed with DT-DKD. Serial post-transplant biopsies showed the histological progression of allograft DN.ConclusionsTo the best of our knowledge, this is the first study to report the phenomenon of ongoing DT-DKD in kidney transplant recipients with fair blood sugar control. The zero-time pre-transplant kidney biopsy may be an important examination before the allocation of diabetic donor kidneys. Further study is needed to elucidate the possible mechanism of ongoing DT-DKD in non-diabetic recipients with fair blood sugar control as well as the impaction of pre-implantation diabetic lesion on the graft outcome.
Highlights
Transplantation with a diabetic donor kidney may have some benefits compared to remaining on the waitlist for selected patients
Based on the clinical data and histopathologic results, the selected recipients were divided into two groups: the biopsy-proven diabetic kidney disease (DKD) group (n = 6) and non-DKD group (n = 17)
In the biopsy-proven DKD group, 5 recipients had no history of diabetes before or after transplantation
Summary
Transplantation with a diabetic donor kidney may have some benefits compared to remaining on the waitlist for selected patients. We found that some kidney transplant recipients have ongoing donortransmitted diabetic kidney disease (DT-DKD) despite fair blood sugar control. Compared to remaining on the waitlist or receiving a kidney from a non-diabetic extended criteria donor, transplantation with a diabetic donor kidney may have benefits for selected patients [6–9]. We found that some kidney transplant recipients have biopsy-proven ongoing diabetic kidney disease (DKD) despite clinical euglycemia and no history of diabetes. We defined this phenomenon as donortransmitted DKD (DT-DKD). The aim of this study was to survey the incidence and clinical pattern of DT-DKD in kidney transplant recipients
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