Availability, Utilization and Outcomes of Deceased Diabetic Donor Kidneys; Analysis Based on the UNOS Registry

The number of kidneys obtained from deceased diabetic donors available for transplantation has increased >eightfold increase in the past 15 years. We assessed allograft outcomes associated with deceased diabetic donors and compared them with that of standard and extended criteria donors (ECD) in the UNOS data registry. We identified 1982 recipients of diabetic standard criteria donors over a 10‐year period from 1995 through 2004. Both overall and death‐censored survival of organs from diabetic standard criteria donors was significantly better than that of organs obtained from nondiabetic ECD while inferior to that from nondiabetic standard criteria donors. Compared with ECD donors, diabetic donors had lower serum creatinine, less cold ischemia and these kidneys were less likely to be pump‐perfused. Recipients of diabetic kidneys were younger and less likely to experience delayed graft function compared with recipient of ECD kidneys. More recently, many diabetic donor kidneys have been given to diabetic recipients with early graft survival being similar to that among nondiabetic recipients. These findings demonstrate the potential to expand and to improve utilization of this resource without compromising outcomes for recipients. Improved, evidence‐based evaluation and allocation of deceased diabetic donor kidneys is needed to optimize their use. The authors perform registry analysis of outcomes associated with kidneys from deceased diabetic donors over a 10‐year period and compare them to outcomes from other marginal donors in the same period. See editorial by Tedesco on page 1969.