Study Reveals Lower Kidney Transplant Chances for Diabetic Candidates Despite Better Survival Rates Post-Transplant

To ensure equitable transplantation opportunities, further investigation is needed to understand the underlying reasons behind this disparity, Adnan Sharif, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK, and colleagues wrote in Diabetologia.

Diabetes is a major public health issue, with 529 million affected globally, projected to rise to 1.32 billion by 2050. It is a leading cause of kidney failure. While kidney transplantation improves survival, studies show poorer long-term outcomes for diabetics compared to non-diabetics. Additionally, there may be inequities in access to transplant services for those with diabetes.

However, It is uncertain whether kidney transplant candidates with diabetes have equal access to transplantation or if their survival outcomes differ based on kidney replacement therapy. Therefore, Dr. Sharif et al. aimed to explore these questions using data from national transplant registries in the UK.

For this purpose, the researchers performed a cohort study of prospectively collected registry data of all wait-listed people with kidney failure receiving dialysis in the UK. The study included all individuals listed for their first kidney-only transplant between 2000 and 2019, stratified by the cause of kidney failure.

The primary outcome was all-cause mortality. Time-to-death from listing was analyzed using adjusted Cox regression models with non-proportional hazards, treating transplantation as a time-dependent variable.

The study led to the following findings:

• 47,917 wait-listed people with kidney failure formed the total study cohort, of whom 13.8% had diabetes classified as the cause of kidney failure.
• People with kidney failure with diabetes comprised 27.6% of the cohort that did not proceed to transplantation vs only 8.4% of the cohort that received a transplant.
• Kidney transplant candidates with diabetes were more likely to be older, of male sex, and ethnic minority background compared with those without diabetes.
• Compared with remaining on dialysis, any kidney transplant provided survival benefits for wait-listed kidney transplant candidates regardless of diabetes as a cause of kidney failure (RR 0.26).

In the national cohort study of kidney failure patients listed for transplantation, undergoing transplant surgery was found to provide a survival benefit for those with diabetes. However, the data indicate that individuals with diabetes may face reduced chances of receiving a transplant, potentially due to selection biases or unexamined comorbidities.

"While survival benefits should be personalized for each candidate, the findings support that transplantation remains the preferred treatment for all suitable patients with kidney failure, including those with diabetes, unless contraindicated," the researchers concluded.

Reference:

Rashid, R., Chaudhry, D., Evison, F. et al. Mortality risk for kidney transplant candidates with diabetes: a population cohort study. Diabetologia (2024). https://doi.org/10.1007/s00125-024-06245-x