Five‐Year Outcomes and Clinicopathological Correlations of Kidney Transplants From Deceased Donors With Diabetes

ABSTRACT Background Kidneys from deceased donors with diabetes mellitus are refused because diabetes is considered a marker of lower organ quality. We evaluated 5‐year outcomes according to donor‐recipient diabetes status and, secondarily, the prognostic value of pre‐implantation histopathological findings among accepted diabetic donor kidneys. Methods This retrospective single‐center cohort study included adult recipients of deceased‐donor kidney transplants performed between 2013 and 2017. Five‐year kidney function and death‐censored graft survival were compared according to donor diabetes status before and after 1:2 propensity score matching. A secondary exploratory analysis evaluated Banff chronicity parameters in pre‐implantation pathology reports. Results Among 3058 recipients, 244 received kidneys from diabetic donors. These donors were older, more frequently hypertensive, and had higher KDPI than non‐diabetic donors. In unadjusted analyses, recipients of diabetic donor kidneys had lower eGFR and death‐censored graft survival. After matching, eGFR from years 1 to 5, eGFR slope, and death‐censored graft survival no longer differed between groups. Recipient diabetes did not significantly modify the association of donor diabetes with graft survival or longitudinal eGFR, although the D+/R+ subgroup was small ( n = 39). Among 164 available pre‐implantation biopsy reports, diabetes‐related glomerular lesions were uncommon, chronic lesions were predominantly vascular and mild to moderate, and no Banff histological parameter independently predicted eGFR <30 mL/min/1.73 m 2 or death‐censored graft loss at 5 years. Conclusions After balancing baseline donor and recipient characteristics, donor diabetes was not associated with significantly lower 5‐year kidney function or death‐censored graft survival. In the secondary clinicopathological analysis, no individual Banff chronicity parameter independently predicted 5‐year outcomes.