Ongoing donor-transmitted diabetic kidney disease in kidney transplant recipients with fair sugar control: a single cent
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RESEARCH ARTICLE
Open Access
Ongoing donor-transmitted diabetic kidney disease in kidney transplant recipients with fair sugar control: a single center retrospective study Chia-Tien Hsu1, Mei-Chin Wen2, Hsien-Fu Chiu1, Shang-Feng Tsai1, Tung-Min Yu1, Cheng-Kuang Yang3, Ming-Ju Wu1 and Cheng-Hsu Chen1*
Abstract Background: Transplantation with a diabetic donor kidney may have some benefits compared to remaining on the waitlist for selected patients. However, we found that some kidney transplant recipients have ongoing donortransmitted diabetic kidney disease (DT-DKD) despite fair blood sugar control. This study aimed to survey the incidence and clinical pattern of DT-DKD in kidney transplant recipients. Methods: We retrospectively reviewed the medical records of kidney transplantations in our hospital. We found 357 kidney transplantations from February 2006 to April 2018. Among these, 23 (6.4%) diabetic donor kidney transplantations were done in the study period. Results: Among the 23 recipients, 6 (26.1%) displayed biopsy-proven DKD. Recipients with biopsy-proven DKD had longer dialysis vintage, higher proteinuria amount, lower last estimated glomerular filtration rate (eGFR), and a more rapid decline in the eGFR. The median fasting blood sugar level in the biopsy-proven DKD group was unexpectedly lower than the non-DKD group. Most of the pre-implantation frozen sections in biopsy-proven DKD group showed diabetic lesions worse than diabetic nephropathy (DN) class IIa. In the biopsy-proven DKD group, 5 recipients had no history of diabetes before or after transplantation. Among the 23 recipients, 5 (21.7%) were diagnosed with DTDKD. Serial post-transplant biopsies showed the histological progression of allograft DN. Conclusions: To the best of our knowledge, this is the first study to report the phenomenon of ongoing DT-DKD in kidney transplant recipients with fair blood sugar control. The zero-time pre-transplant kidney biopsy may be an important examination before the allocation of diabetic donor kidneys. Further study is needed to elucidate the possible mechanism of ongoing DT-DKD in non-diabetic recipients with fair blood sugar control as well as the impaction of pre-implantation diabetic lesion on the graft outcome. Keywords: Donor-transmitted diabetic kidney disease, Kidney transplantation, Diabetes mellitus
* Correspondence: [email protected] 1 Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan Full list of author information is available at the end of the article
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