Early outcomes of kidney transplantation in recipients with type 1 diabetes mellitus and end‑stage kidney disease resulting from diabetic nephropathy

Objective: to analyze early outcomes of kidney transplantation (KT) in patients with type 1 diabetes mellitus (T1D) and stage 5 chronic kidney disease resulting from diabetic nephropathy.

Materials and methods. The study group included 145 T1D patients who underwent KT at the kidney and pancreas transplant department of Sklifosovsky Research Institute for Emergency Medicine between January 1, 2007 and December 31, 2023. Among them were 57 men (39.3%) and 88 women (60.7%), the median age was 41.5 [35–47] years. The median age at disease onset was 14.6 [9–17] years. Organ donors consisted of 100 (69%) men, 40 (27.6%) women, and there was no information on the sex of 5 donors (3.4%). Donor median age was 46 [35.5–53] years.

Results. Ninety-nine recipients (68.3%) had primary renal allograft function (PRAF), whereas 46 recipients (31.7%) had delayed function. The median time for azotemia to normalize was 6 [3; 6] days in PRAF patients and 20.5 [14; 27] days in those with delayed function. Overall, there were 9.7% (n = 14) surgical complications, 12.4% (n = 18) acute rejection crisis, and 9.7% (n = 14) infectious complications. Median serum creatinine and urea levels at discharge were 123 [99–164] μmol/L and 10 [7.4–14] mmol/L, respectively; median fasting blood glucose levels before transplantation and at discharge were 9.8 [7.8; 12] mmol/L and 8.1 [6.5; 10] mmol/L, respectively. A total of 125 patients (86.2%) were discharged with adequately functioning kidney graft, while 13 patients (9%) were discharged with graft dysfunction that did not require renal replacement therapy; one patient (0.7%) was transferred to the outpatient stage of treatment to continue dialysis therapy; however, renal allograft function was restored within 2 months post-transplant.

Conclusion. Although T1D patients remain the most severe category of dialysis patients, our findings suggest that KT is an effective treatment option for them with high graft and recipient survival rates.

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