The Impact of Donor and Recipient Diabetes on Patient and Graft Survival in Kidney Transplant Recipients.

Introduction: With the growing demand for kidney transplants, kidneys from donors with diabetes mellitus are used more frequently. This raises the concerning possibility that a kidney with early-stage diabetic nephropathy may be transplanted into a recipient who subsequently develops posttransplant dysglycemia; however, it is unclear what impact this will have on graft function and survival. This study investigated graft and patient survival when the donor, recipient, or both have diabetes. Methods: Data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry were used to analyze first-time adult recipients of deceased-donor kidneys between 2003 and 2022. Cox proportional hazards models were used to compare primary outcomes of death-censored graft survival and patient survival across combinations of donor and recipient diabetic status. Secondary outcomes of rejection and estimated glomerular filtration rate (eGFR) over time were analyzed with logistic regression and linear mixed models, respectively. Results: The 11,343 recipients included 7377 donor-recipient nondiabetic pairs (D-/R-), 3253 diabetic recipients-nondiabetic donors (D-/R+), 524 nondiabetic recipients-diabetic donors (D+/R-), and 189 both donor and recipient diabetic (D+/R+). Death-censored graft survival was reduced only in the D+/R+ group (adjusted hazard ratio [aHR]: 1.70, 95% confidence interval [CI]: 1.15-2.51, Conclusion: The D+/R+ combination is associated with inferior graft and patient survival and should be considered cautiously. This study supports continued use of diabetic donors with no impact on graft or patient survival in nondiabetic recipients.