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Kidney transplants from diabetic donors will save more lives, sooner

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PHILADELPHIA — There are more than 98,000 people currently awaiting a kidney transplant in the United States. But the organs are in short supply: only about 17,000 patients will receive transplants each year. For sicker patients and those facing the longest wait times — five to seven years or more on the waiting list — a new study finds there may be a benefit to accepting a kidney from a deceased diabetic donor. In a study published today in the Clinical Journal of the American Society of Nephrology, researchers from the Perelman School of Medicine at the University of Pennsylvania, have found that the best chance of survival, for older patients, those who live in areas with long waits for transplantation, or those who already have diabetes, may come from accepting a kidney from a deceased donor who had diabetes.

"Most often, these organs are considered 'high-risk' as diabetes is a risk factor for kidney disease, and there may be underlying kidney damage that is not detected in initial organ screenings prior to transplantation," said lead author Jordana Cohen, MD, MSCE, an instructor of Medicine in the division of Renal-Electrolyte and Hypertension. "However, there are many patients on the wait list who will die before they receive a kidney transplant. For these patients, based on this study, their best chance of survival and of having a better quality of life may come from accepting this kind of organ."

Researchers performed an observational study of 437,619 kidney transplant candidates using data from the Organ Procurement and Transplantation Network database. They identified 8,101 recipients of diabetic donor kidneys and 126,560 recipients of nondiabetic donor kidneys. The team assessed the risk an adverse event after accepting a diabetic donor kidney as compared to remaining on the waitlist or receiving a nondiabetic donor kidney.

"Our goal was to evaluate the mortality risk of transplantation with diabetic donor kidneys compared to remaining on the kidney transplant waitlist, and to determine which patients would benefit most from transplantation with these organs," said senior author Deirdre L. Sawinski, MD, assistant medical director of Kidney Pancreas Transplantation, and an assistant professor of medicine in the division of Renal-Electrolyte and Hypertension. "In this analysis, we were able to determine that kidney transplant candidates who are at highest risk of dying on the waitlist, such as the elderly, patients with diabetes themselves, and those at centers with the longest average waiting times, benefit most from transplantation with diabetic donor kidneys, with a nearly 10 percent improvement in long term survival."

The team also found that poor quality diabetic donor kidneys, as determined by a donor index that takes into account factors such as donor age and kidney function, provide no survival benefit, and that younger kidney transplant candidates–those under age 40 years old–do not benefit from transplantation with diabetic donor kidneys. While kidneys from diabetic donors may not last as long or work as well as kidneys from non-diabetic donors, the initial survival benefits seem to outweigh these risks.

Sawinski added that "patients, who are over the age of 40 or those who already have diabetes, should consider accepting a kidney from a deceased diabetic donor when available, in order to increase their chances of being transplanted sooner, and increasing their survival."

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Additional Penn authors on this study include Kimberly Forde and Peter Reese. This study was supported in part by the National Institutes of Health (K23-HL133843), (K23-DK103918) and (K23-DK090209).

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center — which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report — Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.

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Abbey Anderson
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