# Kidney transplantation with preformed diabetic nephropathy kidney: review of pathological changes and clinical outcomes

## TL;DR

This paper reviews kidney transplants using diabetic nephropathy donor kidneys, finding acceptable outcomes but warning about post-transplant hyperglycemia risks.

## Contribution

The study systematically analyzes the clinical outcomes and pathological changes of kidney transplants using preformed diabetic nephropathy donor kidneys.

## Key findings

- Most transplants using preformed diabetic nephropathy kidneys showed stable or reversed pathological changes.
- Post-transplant hyperglycemia was linked to worse pathological progression in these kidneys.
- Graft survival rates exceeded 80% at five years in most cases.

## Abstract

Kidney transplantation from expanded-criteria donors represents an effective approach to alleviate organ shortages. The feasibility for transplantation of donor kidneys with preformed diabetic nephropathy (DN) has not been extensively investigated.

We performed a literature review to explore the pathological changes and clinical outcomes of kidney transplantation using preformed DN kidney. A systematic and comprehensive search was conducted from the inception to June 13, 2024.

Data from eight articles encompassing 103 cases were included for analysis. The pooled proportions of stable, progressive, and reversed DN-related pathological change were 0.66 (95% CI 0.56–0.77, I2 = 21.77%), 0.27 (95% CI 0.18–0.36, I2 = 10.04%) and 0.05 (95% CI 0.01–0.10, I2 = 0.00%), respectively. Eight-six cases were divided into post-transplant hyperglycemia group and normal post-transplant blood glucose group to evaluate the effect of post-transplant hyperglycemia on DN pathology, indicating the normal post-transplant blood glucose group had higher proportions of stable and reversed pathological states. Most cases achieved a graft survival rate of more than 80% at around five years post-transplant.

A majority of transplantations use donor kidneys with preformed DN exhibit acceptable renal pathological changes and graft survival. However, post-transplant hyperglycemia may adversely affect the pathological progression of the kidneys, particularly in cases with long-term follow-up.