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Abstract: TH-PO154

High Incidence of Recurrent Diabetic Nephropathy in Kidney Transplant Alone (KTA) Recipients

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Kukla, Aleksandra, Mayo Clinic , Rochester, Minnesota, United States
  • Morales Alvarez, Martha Catalina, Mount Sinai Beth Israel, Rochester, Minnesota, United States
  • Bentall, Andrew J., Mayo Clinic , Rochester, Minnesota, United States
  • Alexander, Mariam P., Mayo Clinic , Rochester, Minnesota, United States
  • Issa, Naim S., Mayo Clinic, Rochester, Minnesota, United States
  • Park, Walter, The Mayo Clinic, Rochester, Minnesota, United States
  • D'Costa, Matthew R., Mayo Clinic , Rochester, Minnesota, United States
  • Stegall, Mark D., Mayo Clinic , Rochester, Minnesota, United States
Background

Improving long-term kidney allograft survival is a major challenge. Recurrent diabetic nephropathy (RDN) in kidney transplant recipients is not well studied. We aimed to determine the incidence, timing and severity of recurrent diabetic nephropathy (RDN) in recipients with pre-transplant type 1 (T1DM) and type 2 diabetes (T2DM).

Methods

We studied 118 diabetic transplant recipients (recs) -T1DM ( simultaneous kidney pancreas [SPK] and KTA), and T2DM (all KTA) transplanted between 2002 and 2009. Recs with SPK had functioning pancreas allograft at 5y post transplant. All recs underwent surveillance protocol kidney biopsy at 4 months, 1y, 2 y and 5 y post transplant. RDN was diagnosed based on light microscopy according to Banff 2015 criteria (MM score) and/or as described by pathologist if MM score was not assigned. Advanced RDN was diagnosed if MM score was >1.Patients with immune complex diseases were excluded.

Results

We identified 52 T1DM (46% SPK and 54% KTA) and 66 T2DM (all KTA) recs. T1DM were younger (47y ± 1.3 vs. 62.1y±1.2 for T2DM; p<0.001). BMI was comparable (31.2 T1DM vs. 33.2 T2DM).
The earliest RDN was seen at 1 year post transplant. At 5 years, the incidence of RDN was only 4.3% in T1DM SPK, compared to 34% in T1DM with KTA and 46% in T2DM with KTA (p<0.05). BMI was higher in those with RDN (34.5 vs 29.9; p<0.05) regardless od diabetes type.
13 (11%) recs developed advanced RDN (mm>1) at 5 years. Those recs were more likely to be T2DM (74% vs. 26% for T2DM and T1DM, respectively, p<0.05). Mean HbA1C in this group at 5 y was 8.12%±1.8. Creatinine has not changed over the 5 years post transplant (mean delta creatinine 0.03 ± 0.38). Mean albuminuria at 5 y was 52 mg/24h ± 345. 7 (53 %) of recs with advanced RDN did not have significant albuminuria at 5 years (30 mg/24 h or less).

Conclusion

Histologic changes of RDN can be seen as early as 1 year post kidney transplant and have high incidence at 5 years. HIgh BMI is a risk factor. Pancreas transplantation is associated with histological protection. Advanced RDN is significantly more common in T2DM recipients and may be clinically silent. Future studies should focus on identifying risk factors for RDN, its impact on graft survival and development of better noninvasive biomarkers of histologic injury.