TWENTY YEARS EXPERIENCE OF RENAL TRANSPLANTATION FOR PATIENTS WITH TYPE 2 DIABETES MELLITUS (T2DM). RISK FACTORS THAT INFLUENCE GRAFT AND PATIENT SURVIVAL

DJ GOODMAN¹, S ULLAH^2,3, SP MCDONALD^2,3

¹Department of Nephrology St Vincent’s Hospital Melbourne, Fitzroy, Victoria; ²ANZDATA Registry, Adelaide, South Australia, ³ Adelaide Medical School, University of Adelaide, Adelaide, South Australia.

Aims: To examine factors in T2DM recipients at time of transplantation to identify risk factors influencing graft and patient survival (G/PS).

Background: The number of dialysis patients with T2DM has increased over the past 20 years with more patients being considered for and undergoing renal transplantation.

Methods: Data for all adult first transplant recipients 1995-2014 was extracted from ANZDATA. Age, gender, BMI, smoking, history of coronary artery disease (CAD), cerebrovascular disease (CVD), peripheral vascular disease (PVD), indigenous status, dialysis duration, donor source and HLA matching.  A Cox model was used to predict G/PS.

Results: Of 12 229 patients transplanted 12% had T2DM. The proportion of T2DM patients climbed from 1.4% (1995) to 12.4% (2014). Over 74% of all T2DM transplants were performed in the last 10 years. Due to the small numbers of transplants performed before 2005 and changes in immunosuppression we restricted analysis to transplants performed between 2005-2014. T2DM recipients were older, more obese (BMI>30), have more CAD, CVD and PVD. More Indigenous Australians were in T2DM group. T2DM had longer dialysis waiting times, and received higher proportion of deceased donor kidneys. (All comparisons significant P<0.001)

When outcomes between 2005-2009 and 2010-2014 were compared T2DM recipients had improvement in G/PS (P=0.04 & P=0.03). Non-T2DM, G/PS, P=0.57 & P=0.91. Of the medical co-morbidities, only PVD was a significant risk factor in T2DM (Hazard ratio: G/PS 1.38 & 1.59) whereas smoking, CAD & PVD were risk factors for non-T2DM G/PS.

Conclusions: More patients with T2DM are receiving kidney transplants and the outcomes continue to improve. The risk factors that influence G/PS vary between T2DM and non-T2DM recipients and should be considered during transplant work up.