Background: Classical medical teaching suggests that diabetic nephropathy occurs more quickly in transplanted kidneys than in the native kidneys. The largest report of post-transplantation diabetic nephropathy (DN) in patients with pre-transplantation diabetes included 22 patients. The true risk of developing post-transplantation DN remains unknown and post-transplantation DN is poorly characterized in the literature.

Methods: Our institution's pathology database was screened for patients diagnosed with transplant DN in the last 10 years; Biopsies were for cause. The transplant database was then cross-referenced to learn more about pre-transplant diabetes status for those who developed diabetic nephropathy after transplantation. Time from transplantation to biopsy-proven DN (time to diagnosis, TTD) was analyzed in the context of demographics, serum creatinine, and onset of diabetes. Histology slides were reviewed for pathological class of DN.

Results: We identified 60 patients with pre-transplantation type II diabetes who had biopsy-proven DN after kidney transplantation. The mean age was 55.8 (+/- 1.60) years, and the mean creatinine level at time of biopsy was 1.68 (+/- 0.11) mg/dL. Simultaneous pathological diagnoses were frequent on kidney biopsy; rejection was present at variable rates: classes I, IIA, IIB, and III were 5.0%, 66.7%, 18.4%, and 10%, respectively. The mean TTD was 1456 (+/- 206) days. TTD was significantly shorter for patients receiving a cadaveric versus living donor renal transplant (1118 +/- 184 vs 2470 +/- 547 days, p=0.0036). Older patients (r=0.378, p=0.003) and patients with higher serum creatinine (r=0.282, p=0.029) had shorter TTDs. Gender and ethnicity did not significantly affect TTD. Insulin doses were higher for those patents who developed DN earlier. The average one-year incidence of diabetic nephropathy was 2.88%. Informed by these data, extrapolations showed that 74.7% of patients would be free of DN 10 years after renal transplantation.

Conclusions: Diabetic patients undergoing renal transplantation have a small, but real risk for developing post-transplantation DN and this risk is higher for recipients of cadaveric grafts. When it occurs, DN presents occurs later than previously thought. Blood sugar optimization for patients with type II diabetes may improve rates of DN.

CITATION INFORMATION: Cimeno A., Munley J., Sultan S., Weir M., Bartlett S., Drachenberg C., Hararian A., Bromberg J., Scalea J. Diabetic Nephropathy after Kidney Transplantation in Patients with Pre-Transplantation Type II Diabetes May Occur Later and Be Less Common Than Previously Thought Am J Transplant. 2017;17 (suppl 3).

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