A case control study of renal transplantation in patients with type I diabetes.

A case control study was undertaken comparing the outcome of 208 renal allografts transplanted into diabetic recipients with those transplanted into an appropriately matched group of non-diabetic recipients. In each group there were 151 cadaver, 21 two-haplotype identical, 35 one-haplotype identical, and one zero-haplotype identical living-related grafts. For the entire group of diabetics, 1- and 5-year graft survivals were 71.3% and 46%. Graft survivals for the non-diabetic recipients at 1 and 5 yr were 81.8% and 57.8% (p less than 0.05). In all patient subgroups divided according to the donor source, the graft and patient survival rates for the non-diabetic recipients exceeded those of the diabetic recipients. One- and 5-yr diabetic patient survivals were 90% and 70%, and for the non-diabetics they were 97% and 95%, respectively (p less than 0.001). There were 40 deaths among diabetics and 15 among the non-diabetics. Cardiovascular disease was the major cause of death in the diabetics, accounting for 40% of the deaths. In addition, allograft loss due to patient death was a significant cause of graft loss in the diabetic group, 24 grafts (28%). Seven grafts (10%) were lost due to patient death in the non-diabetic group (p less than 0.05). Post-transplant, diabetic recipients had a greater incidence of stroke, angina, myocardial infarction, peripheral vascular disease, urinary tract infections (p less than 0.01 for each), and wound infections (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)