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

Abstract

Aim: To 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. Method: MEDLINE, EMBASE, Renal transplant registries were searched for observational/cohort/casecontrol studies from 1980 to 2015. Results: We 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 DMvs 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 10 yrs, 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. Conclusion: Results 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.

Keywords

• Diabetes mellitus
• Dialysis
• Graft survival
• Transplant
• Renal insufficiency