Increasing prevalence of cardiovascular disease in kidney transplant patients with Type 1 diabetes.

Type 1 diabetes was evaluated as a risk factor in kidney transplantation with respect to cardiovascular disease and with focus on changes over time. From 1985 to 1993, 159 Type 1 diabetic patients received first kidney transplants in Göteborg. Actual 5 year-survival of diabetic patients was 75% compared to 94% for matched controls, P < 0.0001, and survival of grafts was 60% compared to 75%. In the diabetic group, high age and preexisting coronary heart disease were additional, independent risk factors. When patients were divided into three groups according to time of transplantation, survival was found to improve initially but then declined, P = 0.03. Patients in the last group were older and 39% had pre existing vascular disease. The fact that Type 1 diabetic patients now reach end-stage renal failure at a higher age and with more established vascular disease calls for careful evaluation of a larger proportion of the transplant candidates.