---
title: "Five-Year Outcomes of Kidney Transplants From Deceased Donors With Diabetes: Function and Pathology"
id: "pubmed-42804549"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42804549"
content_type: "clinical_feed_article"
specialty: "Nephrology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42804549/"
doi: "10.1111/ctr.70698"
published_at: "2026-10-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Five-Year Outcomes of Kidney Transplants From Deceased Donors With Diabetes: Function and Pathology
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42804549
- **Specialty:** [Nephrology](https://medichelpline.com/clinical-feed/nephrology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42804549/)
- **DOI:** [10.1111/ctr.70698](https://doi.org/10.1111%2Fctr.70698)
- **Published At:** 2026-10-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This single-center retrospective cohort evaluated 5-year outcomes of adult deceased-donor kidney transplants performed between 2013 and 2017, comparing kidneys from donors with and without **diabetes**. - The study cohort included 3058 recipients; 244 received kidneys from diabetic donors. - Donors with diabetes were older, had more hypertension, and higher KDPI than non-diabetic donors. - Unadjusted analyses showed recipients of kidneys from diabetic donors had lower **eGFR** and worse death-censored graft survival. - After 1:2 propensity score matching to balance donor and recipient baseline characteristics, differences in eGFR (years 1–5), eGFR slope, and death-censored graft survival were no longer statistically significant. - Recipient diabetes status did not significantly modify the association between donor diabetes and graft survival or longitudinal eGFR; the combined donor+/recipient+ subgroup was small (n = 39). - A secondary exploratory analysis examined 164 available pre-implantation biopsy reports from accepted diabetic donor kidneys. - Diabetes-related glomerular lesions were uncommon in these biopsies; chronic lesions were mainly vascular and graded mild to moderate. - No individual Banff chronicity parameter independently predicted 5-year outcomes defined as eGFR <30 mL/min/1.73 m2 or death-censored graft loss. - The authors conclude that, after balancing baseline characteristics, donor diabetes was not associated with significantly lower 5-year kidney function or death-censored graft survival in this cohort, and pre-implantation Banff parameters did not independently predict 5-year outcomes.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Nephrology Division, Federal University of São Paulo, São Paulo, Brazil. * 2 Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil. * PMID: **42804549** * PMCID: [ PMC13619057 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13619057/) * DOI: [ 10.1111/ctr.70698 ](https://doi.org/10.1111/ctr.70698) Item in Clipboard # Five-Year Outcomes and Clinicopathological Correlations of Kidney Transplants From Deceased Donors With Diabetes Marina Colella-Santos et al. Clin Transplant. 2026 Oct. Show details Display options Display options Format Abstract PubMed PMID Clin Transplant Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Clin+Transplant%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Clin+Transplant%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804549/) . 2026 Oct;40(10):e70698. doi: 10.1111/ctr.70698. ### Authors [Marina Colella-Santos](https://pubmed.ncbi.nlm.nih.gov/?term=Colella-Santos+M&cauthor_id=42804549)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-1 "Nephrology Division, Federal University of São Paulo, São Paulo, Brazil."), [Pedro Henrique Pepato](https://pubmed.ncbi.nlm.nih.gov/?term=Pepato+PH&cauthor_id=42804549)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-1 "Nephrology Division, Federal University of São Paulo, São Paulo, Brazil."), [Henrique Machado de Sousa Proença](https://pubmed.ncbi.nlm.nih.gov/?term=Proen%C3%A7a+HMS&cauthor_id=42804549)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-2 "Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil."), [Luiz Antonio Ribeiro de Moura](https://pubmed.ncbi.nlm.nih.gov/?term=Moura+LAR&cauthor_id=42804549)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-1 "Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-2 "Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil."), [José Medina-Pestana](https://pubmed.ncbi.nlm.nih.gov/?term=Medina-Pestana+J&cauthor_id=42804549)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-1 "Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-2 "Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil."), [Renato Demarchi Foresto](https://pubmed.ncbi.nlm.nih.gov/?term=Foresto+RD&cauthor_id=42804549)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-1 "Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-2 "Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil."), [Lúcio Requião-Moura](https://pubmed.ncbi.nlm.nih.gov/?term=Requi%C3%A3o-Moura+L&cauthor_id=42804549)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-1 "Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42804549/#short-view-affiliation-2 "Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.") ### Affiliations * 1 Nephrology Division, Federal University of São Paulo, São Paulo, Brazil. * 2 Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil. * PMID: **42804549** * PMCID: [ PMC13619057 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13619057/) * DOI: [ 10.1111/ctr.70698 ](https://doi.org/10.1111/ctr.70698) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## 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 m2 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. **Keywords:** Banff classification; deceased donor; diabetes mellitus; estimated glomerular filtration rate; graft survival; kidney transplantation; pre‐implantation biopsy. © 2026 The Author(s). Clinical Transplantation published by John Wiley & Sons Ltd. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement The authors declare no conflicts of interest. ## Figures [ ![FIGURE 1](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca52/13619057/65a00c8857db/CTR-40-e70698-g001.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca52/13619057/e4824ed0dc7e/CTR-40-e70698-g001.webp) ** FIGURE 1 ** Mean estimated glomerular filtration rate… ** FIGURE 1 ** Mean estimated glomerular filtration rate over 5 years according to donor diabetes status… **FIGURE 1** Mean estimated glomerular filtration rate over 5 years according to donor diabetes status in the overall cohort (A) and after propensity score matching (B). Error bars represent 95% confidence intervals. DM+, donor with diabetes mellitus; DM‐, donor without diabetes mellitus. [ ![FIGURE 2](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca52/13619057/8418b7b91db0/CTR-40-e70698-g003.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca52/13619057/9d2af684695c/CTR-40-e70698-g003.webp) ** FIGURE 2 ** Death‐censored graft survival according to… ** FIGURE 2 ** Death‐censored graft survival according to donor diabetes status in the overall cohort (A),… **FIGURE 2** Death‐censored graft survival according to donor diabetes status in the overall cohort (A), after propensity score matching (B), and according to combined donor and recipient diabetes status in the overall cohort (C). D‐/R‐, nondiabetic donor/nondiabetic recipient; D‐/R+, nondiabetic donor/diabetic recipient; D+/R‐, diabetic donor/nondiabetic recipient; D+/R+, diabetic donor/diabetic recipient. [ ![FIGURE 3](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca52/13619057/7894c68fec86/CTR-40-e70698-g002.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca52/13619057/b24c8cb02156/CTR-40-e70698-g002.webp) ** FIGURE 3 ** Propensity score distribution according to… ** FIGURE 3 ** Propensity score distribution according to donor diabetes status before and after 1:2 propensity… **FIGURE 3** Propensity score distribution according to donor diabetes status before and after 1:2 propensity score matching. DM+, donor with diabetes mellitus; DM‐, donor without diabetes mellitus. [See this image and copyright information in PMC](https://pubmed.ncbi.nlm.nih.gov/42804549/) ## Similar articles * [ Baseline Vascular Pathology in Deceased Donor Kidneys: Differential Impact on Transplant Outcomes by Donor Type. ](https://pubmed.ncbi.nlm.nih.gov/41004140/) Sageshima J, Goussous N, Kelly Y, Loseth C, Alghannam K, Chen LX, Matsuoka L, Alexopoulos S, Perez R, Jen KY.Sageshima J, et al.Clin Transplant. 2025 Oct;39(10):e70332. doi: 10.1111/ctr.70332.Clin Transplant. 2025.PMID: 41004140 * [ "Rethinking High-KDPI Kidneys: A Multidomain Approach to Predicting Success". ](https://pubmed.ncbi.nlm.nih.gov/41637670/) Zhang X, Puttarajappa C, Spitz F, Mial-Anthony J, Demirors B, Abdullah A, Sethi V, Lin MY, Crane A, Cashion W, Elias C, Shwe H, Fokken T, Phelp B, Takahashi R, Liu H, Kaltenmeier C, Dharmayan S, Gunabushanam V, Ganoza A, N Wijkstrom M, Tevar A, Molinari M.Zhang X, et al.Clin Transplant. 2026 Feb;40(2):e70472. doi: 10.1111/ctr.70472.Clin Transplant. 2026.PMID: 41637670Free PMC article. * [ Outcomes of Kidney Transplants From Donors With Stage 3 Acute Kidney Injury Requiring Dialysis: A National Cohort Study. ](https://pubmed.ncbi.nlm.nih.gov/41954271/) Paulus AB, Gupta G, Gungor A, Toll A, Lewis A, Martinez C, McCharen C, Cherikh W, Tanriover B.Paulus AB, et al.Clin Transplant. 2026 Apr;40(4):e70535. doi: 10.1111/ctr.70535.Clin Transplant. 2026.PMID: 41954271Free PMC article. * [ Comparable outcomes for old, older, and very old deceased donors in old kidney transplant recipients. ](https://pubmed.ncbi.nlm.nih.gov/41525909/) de Boer SE, Tegzess E, Kremer D, Bemelman FJ, Christiaans MHL, Hilbrands LB, de Vries APJ, de Vries DK, van de Wetering J, Kimenai HJAN, van Zuilen AD, Moers C, Berger SP, Sanders JF.de Boer SE, et al.Am J Transplant. 2026 May;26(5):1087-1099. doi: 10.1016/j.ajt.2026.01.003. Epub 2026 Jan 10.Am J Transplant. 2026.PMID: 41525909 * [ The impact of kidney donor profile index on delayed graft function and transplant outcomes: A single-center analysis. ](https://pubmed.ncbi.nlm.nih.gov/29314286/) Zens TJ, Danobeitia JS, Leverson G, Chlebeck PJ, Zitur LJ, Redfield RR, D'Alessandro AM, Odorico S, Kaufman DB, Fernandez LA.Zens TJ, et al.Clin Transplant. 2018 Mar;32(3):e13190. doi: 10.1111/ctr.13190.Clin Transplant. 2018.PMID: 29314286Free PMC article.Clinical Trial. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42804549) ## References 1. 1. Stevens P. E., Ahmed S. B., Carrero J. J., et al., “Kidney Disease: Improving Global Outcomes CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease,” Kidney Internationa
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