Nav: Home

Kidneys from diabetic donors may benefit many transplant candidates

May 25, 2017

Highlights
  • Patients who received kidney transplants from donors with diabetes had better survival compared with those who remained on the waitlist.
  • Patients at high risk of dying while on the waitlist and those at centers with long wait times may benefit the most from transplantation with kidneys from diabetic donors.
  • More than 100,000 people are on the kidney transplant waiting list in the United States.

Washington, DC (May 25, 2017) -- A new study indicates that receiving donor kidneys from individuals with diabetes may offer a greater survival benefit than remaining on the waitlist for many transplant candidates. The findings, which appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), may help address the growing organ shortage.

As the demand for deceased donor kidneys increases, physicians and kidney transplant candidates need better information about the risks associated with using high risk donor kidneys--such as those from individuals with diabetes--to inform their decisions about whether to accept these organs.

Jordana Cohen, MD, MSCE (Perelman School of Medicine at the University of Pennsylvania) performed an observational study of 437,619 kidney transplant candidates from the Organ Procurement and Transplantation Network database in the United States, including 8101 recipients of diabetic donor kidneys and 126,560 recipients of non-diabetic donor kidneys. The investigators evaluated patients' risk of dying after transplantation with diabetic donor kidneys compared with remaining on the kidney transplant waitlist.

Among transplant recipients who were followed for a median of 8.9 years, the mortality rate was 35 deaths per 1000 person-years. (A person-year is the number of years of follow-up multiplied by the number of people in the study.) Compared with patients who remained on the waitlist or waited for a kidney from a non-diabetic donor, patients who received a diabetic donor kidney had a 9% lower risk of dying during the study. Kidney transplant candidates who were at high risk of dying on the waitlist, especially at centers with the longest average waiting times, benefitted most from transplantation with kidneys from diabetic donors. Poor quality diabetic donor kidneys provided no survival benefit. Also, young kidney transplant candidates (under age 40 years) did not benefit from transplantation with diabetic donor kidneys.

"As kidney disease has become increasingly common in the United States over the past few decades, the need for kidneys to be donated far exceeds the number of available kidneys. As a result, poorer quality kidneys are increasingly being used as a way to try to decrease transplant waiting times and thus decrease the number of people who die while waiting for a kidney transplant," said Dr. Cohen.

In an accompanying editorial, Richard Formica Jr., MD (Yale University School of Medicine) noted that the study provides important data to support the use of deceased donor kidneys that are likely to be discarded. "However, as important as this finding is, it is necessary to view it in the context of the larger problem facing the nephrology community as it struggles to care for patients with end stage renal disease [ESRD]." He stressed that only a small percentage of money spent on ESRD-associated therapies is allocated to kidney transplantation despite the fact it is superior to dialysis. Moreover, when compared with dialysis, providing transplant care costs much less per year of treatment. "Given the magnitude of the health care crisis posed by ESRD and its toll in terms of human and financial costs, it is unfortunate that despite spending 17.4% of its GDP on healthcare the United States does not focus more of its resources on solving the problem through increasing access to kidney transplantation."
-end-
Study co-authors include, Kevin C. Eddinger, MD, Jayme E. Locke, MD, MPH, Kimberly A. Forde, MD, MHS, Peter P. Reese, MD, MSCE, and Deirdre Sawinski, MD.

Disclosures: Dr. Locke serves as a clinical consultant for Infusion Pharma and Sanofi. The research was supported in part by the National Institutes of Health grant numbers K23-HL133843 (NHLBI, PI: Cohen), K23-DK103918 (NIDDK, PI: Locke), and K23-DK090209 (NIDDK, PI: Forde). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the National Institutes of Health.

The article, entitled "Survival Benefit of Transplantation with a Deceased Diabetic Donor Kidney Compared with Remaining on the Waitlist," will appear online at http://cjasn.asnjournals.org/ on May 25, 2017, doi: 10.2215/CJN.10280916.

The editorial, entitled "Opportunities to Increase Availability of Deceased Donor Kidneys," will appear online at http://cjasn.asnjournals.org/ on May 25, 2017.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 17,000 members representing 112 countries. For more information, please visit http://www.asn-online.org or contact the society at 202-640-4660.

American Society of Nephrology

Related Kidney Transplant Articles:

New blood test can detect rejection by antibodies after kidney transplant
A group of European scientists led by KU Leuven has found a biomarker that can identify patients with symptoms of kidney rejection symptoms after a transplant as a result of antibodies.
Measuring quality of life after pediatric kidney transplant
After receiving a kidney transplant, children may experience worrisome quality-of-life changes that underscore the importance of screening transplant recipients for psychosocial function, according to Children's research presented during the 10th Congress of the International Pediatric Transplant Association.
dnDSA and ethnicity linked with thickening of blood vessels after kidney transplant
Children who developed anti-human leukocyte antibodies against their donor kidney, known as de novo donor-specific antibodies, were more likely to experience carotid intima-media thickening than those without these antibodies, according to preliminary research presented May 7, 2019, during the 10th Congress of the International Pediatric Transplant Association.
Kidney transplant patients need even better aftercare!
Kidney transplantation is the best renal replacement therapy available. Although survival and quality of life are significantly better compared to dialysis patients, transplant recipients nevertheless have a significantly higher cardiovascular morbidity and mortality than healthy people.
Marijuana use has no effect on kidney transplant outcomes
A new study published in Clinical Kidney Journal indicates that the usage of marijuana by kidney donors has no measurable effect upon the outcomes of kidney transplants for donors or recipients.
More Kidney Transplant News and Kidney Transplant Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...