Prognostic Analysis of Allogeneic Kidney Transplantation with Donation After Circulatory Death Donors Accompanied by Diabetic Kidney Disease

Background: The shortage of organs necessitates the expanded use of marginal donors in Donation After Circulatory Death (DCD). This study aimed to evaluate the outcomes and histopathological changes in donor kidneys affected by diabetic kidney disease (DKD) through baseline (time-zero) and serial postoperative biopsies. Methods: We analyzed 10 patients who received kidneys from DCD donors with DKD between September 2021 and April 2025 at The Second Affiliated Hospital, Nanjing Medical University. All recipients underwent protocol biopsies at 3 and 12 months post-transplantation. Baseline donor and recipient characteristics were summarized. Graft histopathological evaluations of diabetes-related changes were performed. One-way ANOVA was used to assess renal pathological alterations. Results: Two recipients had a history of Diabetes Mellitus (DM), and one developed Post-Transplant Diabetes Mellitus (PTDM). Renal graft function remained stable at 3 months (eGFR 60.78±20.55 mL/min/1.73 m2) and at 12 months (eGFR 58.93±15.76 mL/min/1.73 m2). Urine protein decreased significantly from 472.48±632.25 mg/d at 3 months to 280.45±228.54 mg/d at 12 months after kidney transplantation (P < 0.001). Pathological assessments indicated progression of diabetic lesions in glomeruli, interstitium, and vessels at 3 and 12 months compared to baseline, except for improved vascular lesions. Interstitial fibrosis increased from 19.1% (baseline) to 31.9% (3 months) and 38.9% (12 months). Mesangial expansion worsened significantly at 12 months, while glomerular volume remained stable. Conclusion: This study evaluated outcomes in recipients of DCD kidneys with DKD. These grafts exhibited controlled pathological progression within 12 months after transplantation, with stable renal graft function. Precise screening and risk stratification of donor kidneys with DKD could safely expand the donor pool. Funding: Government Support – Non-U.S.