Renal transplantation in diabetic patients
Renal transplantation in diabetic patients
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DOI：
10.1016/j.transproceed.2006.02.054
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发表时间：
2006-04-01
影响因子：
0.9
通讯作者：
Massari, P. U.
中科院分区：
文献类型：
--
作者：
Bittar, J.;Cepeda, P.;Massari, P. U.
目标。糖尿病是终末期肾脏疾病（ESRD）和血液透析入院的主要原因之一，这一人群对肾移植的需求有所增加。我们的目的是通过将糖尿病患者与非糖尿病人群进行比较来评估肾移植患者的临床方面和生存率。材料与方法。本研究评估了1994年至2003年期间移植的患者。根据变量类型，采用卡方检验和Student t检验分析移植和人口统计学特征。Kaplan-Meier曲线和log-rank检验用于评估移植物和患者存活率。在总共523例连续肾移植中，35例（6.6%）为糖尿病患者，年龄大于非糖尿病患者（47 +/- 11岁vs 37 +/- 16岁，P < .002）。患者接受环孢素（84.3%）、他克莫司（11.2%）、硫唑嘌呤（46.6%）、霉酚酸酯（43.5%）和类固醇（所有患者）的免疫抑制治疗。糖尿病患者的活体供体比例较高（33.5% vs 17.2%; P = 0.04）。糖尿病患者1、3、5年的移植存活率分别为82.7%、70.9%、63.0%，非糖尿病患者为87.6%、79.0%、72.5% （P = 0.6）。糖尿病患者5年生存率为90.5%，非糖尿病患者为89.0% （P = 0.9）。在我们的研究中，糖尿病患者与非糖尿病患者在移植并发症或生存方面没有发现差异。肾移植，即使是活体供体，也必须毫无保留地提供给经过精心挑选的糖尿病患者。
Objective. Diabetes is one of the main causes of end-stage renal disease (ESRD) and admission to hemodialysis, and the demand for kidney transplantation in this population has increased. Our aim was to evaluate the clinical aspects and survival of diabetic patients with kidney transplants by comparing them with the nondiabetic population.Materials and Methods. Patients transplanted during the period from 1994 to 2003 were evaluated for this study. The transplant and demographic characteristics were analyzed by the chi-square test and Student t test according to the type of variable. Kaplan-Meier curves and the log-rank test were used to evaluate the graft and patient survival.Results. From a total of 523 consecutive renal transplants, 35 (6.6%) were diabetics who were older than nondiabetics (47 +/- 11 years vs 37 +/- 16, P < .002). Patients received immunosuppression with cyclosporine (84.3%), tacrolimus (11.2%), azathioprine (46.6%), mycophenolate mofetil (43.5%), and steroids (all patients). The diabetic patients had a higher percentage of living donors (33.5% vs 17.2%; P = .04). Graft survival rates at 1, 3, and 5 years were 82.7%, 70.9%, and 63.0% in the diabetic patients and 87.6%, 79.0%, and 72.5% (P = .6) in the nondiabetic patients. Patient survival at 5 years was 90.5% in diabetic patients vs 89.0% in nondiabetic patients (P = .9).Conclusions. No differences were found in our series in transplant complications or survival in the diabetic patients compared with the nondiabetic patients. Kidney transplants, even with living donors, must be offered to well-selected diabetic patients without reservations.