Early kidney transplant may benefit some diabetics

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In certain patients with diabetes-related kidney disease, performing a transplant before the need for dialysis arises seems to be advantageous, researchers report.

“Preemptive transplantation remains an optimal form of kidney replacement therapy for individuals with diabetes when they receive a living donor kidney—or when they receive a simultaneous pancreas-kidney transplant, in the case of individuals with type 1 diabetes,” Dr. Bryan N. Becker told Reuters Health.

Becker, at the University of Wisconsin-Madison, and colleagues note in the Annals of Internal Medicine that reports show that the technique is effective when used before the onset of chronic dialysis. However, a number of details are lacking.

To investigate further, the researchers examined U.S. national data on more than 23,000 patients with type 1 and type 2 diabetes who received kidney transplants from living or deceased donor, or simultaneous pancreas-kidney transplantation.

In all, preemptive transplantations were received by 14.4 percent of patients with diabetes type 1 and 6.7 percent of patients with diabetes type 2.

After adjusting for factors including age, sex and race, preemptive transplantation was associated with a lower risk of dying in both type 1 and type 2 diabetics only when the transplant was from a living donor. For simultaneous pancreas-kidney recipients, benefit was seen only in those with type 1 diabetes.

The apparently reduced benefit from preemptive transplantation from deceased donors, compared to that seen in the early 1990s, deserves further study, the team concludes.

SOURCE: Annals of Internal Medicine, January 6, 2006.

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