Special considerations for kidney transplantation in Diabetic Nephropathy

Are there any special considerations for kidney transplantation in a patient with Diabetic Nephropathy?

Cardiovascular disease is the most common cause of death in patients with diabetes following kidney transplantation.

Thus, in addition to typical pretransplant candidacy screening, all patients with diabetes should undergo coronary artery disease screening.

They do not necessarily need screening for cerebrovascular disease unless there is history of a transient ischemic attack or cerebrovascular attack.

Peripheral vascular disease (PVD) can prevent a successful anastomosis of the allograft, thus screening for PVD should be considered, particularly if there are any signs or symptoms of PVD.

Another important consideration is the presence of diabetic foot wounds, which need to be completely healed prior to a transplantation.

The risk for histopathologic recurrence of DN in the transplanted kidney is high at 80% to 100%, with changes being seen as early as 2 to 3 years post transplant. For this reason, meticulous glycemic control is important before and after transplantation.

The use of glucocorticoids should be avoided, when possible, to decrease the risk of uncontrolled DM.

Patients with ESKD from type 1 DM should be considered for pancreas transplantation. This is often done in the form of simultaneous kidney-pancreas (SPK) transplant, although pancreas after kidney (PAK) transplant is also performed in patients who already have a kidney transplant.

Recurrent and de novo DN is prevented with a successful pancreas transplant.

15585

Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information

15856