How does diabetes affect renal transplantation?
Patients with Type I diabetes mellitus (juvenile or insulin-dependent) and end-stage renal disease (ESRD) are good renal transplantation candidates. Patients with Type II diabetes mellitus (adult onset or non-insulin-dependent) were not considered good candidates for renal transplanta-tion until recently. In the past, less than 15% of these patients received renal allografts. Type II diabetes mellitus is associated with a higher incidence of vasculopathies, especially involving the renal arteries, which complicate graft anastomoses. With improved anesthetic and surgical techniques, graft survival rates for Type II diabetics with ESRD have improved dramatically. Non-insulin-requiring diabetes tends to occur in older patients as compared with Type I diabetes. Consequently, Type II diabetics frequently present with concomitant medical problems.
Previously, left ventricular dysfunction was also a contraindication to renal transplantation. However, uremic cardiomyopathy has been proven to be reversible with successful renal allografts.