The influence of recipient’s pre-existing diabetes mellitus on outcomes of living donor kidney transplant

Abstract

Objective: To determine the influence of recipients’ pre-existing diabetes mellitus on the outcomes of living donor kidney transplantation.

Methodology: This prospective observational cohort study included 202 patients who underwent kidney transplantation between September 2022 and December 2023 at Dow University Hospital, Pakistan, and were stratified into two equal groups: pre-existing diabetes and non-diabetes. Patients with new-onset diabetes after transplantation were excluded. Demographic and clinical data were collected. Outcomes, including one-year patient survival and post-transplant complications, were assessed and compared.

Results: Complications were high in the pre-existing diabetes group (57.4% vs. 28.7%, p <0.001). Infections occurred in 46.5% of patients with pre-existing diabetes versus 22.8% non-DM (p <0.001). Post-transplant cardiovascular events were observed in 6.9% of patients in the pre-existing DM group, whereas none were observed in the non-DM group (p = 0.014). One-year patient survival was 88.1% in the pre-existing DM group versus 95% in the non-DM group (p = 0.075). Graft-related complications did not differ significantly between the groups. Multivariate analysis identified pre-transplant congestive heart failure (HR = 99.431, [95% CI 7.709–128.441, p <0.001]), pre-transplant peripheral vascular disease (HR =7.787, [95% CI 1.197–50.682, p = 0.032]), post-transplant cardiovascular events (HR = 7.839, [95% CI 1.423–43.198, p = 0.018]), and post-transplant FBS (HR = 1.023, [95% CI 1.001–1.046, p = 0.040]) as independent predictors of mortality.

Conclusion: Diabetes did not influence one-year patient survival and graft-specific outcomes but led to frequent post-transplant complications. Pre- and post-transplant cardiovascular disease and elevated post-transplant FBS levels were associated with mortality. Therefore, structured pre-transplant cardiovascular assessment and optimization, ongoing post-transplant cardiovascular surveillance, and strict glycemic control are required.