Introduction: To evaluate the long-term impact of diabetic donor kidneys on recipients' outcomes through a thorough analysis utilizing propensity score matching.
Methods: The study included 3,059 kidney transplant recipients from deceased donors transplanted between 2013-2017 at a single Brazilian center, with the last follow-up data collected in December 2022. Recipients were categorized based on the diabetic status of donors (DM+ or DM-). Outcomes were 5-year eGFR (ml/min/1.73m2, estimated by CKD-EPI, and imputed using LOCF) and non-censored graft survival. Initial analyses encompassed the entire patient cohort, followed by a propensity score (PS) matching analysis in a 1:2 ratio (DM+:DM-).
Results: The frequency of DM+ donors was 8%. The recipients from DM+ donors were older (51.1 vs. 49.5, p=0.02), with lower frequency of class I PRA>0 (23.8 vs. 25.4%, p=0.01), retransplantation (3.3 vs. 7.7%, p=0.01), and zero HLA A mismatches (12.7 vs. 19.2%, p<0.001). The DM+ donors were older (56.0 vs. 48.0, p<0.001), with a higher frequency of hypertension (79.9 vs. 37.4%, p<0.001) and a lower frequency of traumatic brain death (16.8 vs. 31.8%, p<0.001). Consequently, DM+ more frequently met UNOS expanded criteria (70.1 vs. 34.0%, p<0.001) and higher KDPI (92.5 vs. 67.0, p<0.001). Before matching, 5-yr eGFR was 36.9 for DM- recipients and 28.9 for DM+, p<0.001, but with no difference in the 5-yr graft survival: 72.9 vs. 70.2%, p=0.28. Using PS, the recipient and donor ages, PRA, retransplantation, HLA A mismatches, hypertension in donors, and cause of brain death were controlled. After matching (n=244 vs. 488), 5-yr eGFR and graft survival were similar between both groups: 28.9 vs. 29.7 (p=0.59), and 70.2% vs. 65.1% (p=0.28), for DM+ and DM-, respectively.
Conclusions: Although diabetic donor kidneys exhibited several demographic differences, propensity score matching revealed that the presence of diabetes in donors was not independently associate with inferior long-term graft function or survival.