Utilization of diabetic donor kidneys has increased, though scarce patient and allograft survival data are available for recipients of these organs. Using United Network for Organ Sharing registry data, we performed a study of all US kidney recipients transplanted 3/11/1994-12/3/13. We used multivariable cox analyses to compare outcomes between pairs of recipients receiving a kidney from the same donor, stratified by diabetes status of both donor and recipient. Among pairs where one recipient was diabetic and the mate recipient was non-diabetic, 1,539 received diabetic donor kidneys; 21,459 received non-diabetic donor kidneys. In recipients of diabetic donor kidneys, non-diabetic recipients had lower rates of graft failure (adjusted HR 0.81, 95% CI 0.67-0.96, p = 0.02) and death (adjusted HR 0.65, 95% CI 0.52-0.82, p 0.001) compared to diabetic mate-kidney recipients. There was no difference in the rate of graft failure when diabetic recipients of non-diabetic donor kidneys were compared with non-diabetic recipients of diabetic donor kidneys. Diabetic donor kidneys are associated with increased risk of graft loss and death compared to non-diabetic donor kidneys, especially in diabetic recipients.

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