IMPACT OF HIGH DIABETES MELLITUS PREVALENCE ON KIDNEY TRANSPLANTATION IN MAURITIUS

Introduction:

Mauritius has one of the highest rates of both diabetes mellitus (DM) and chronic kidney disease (CKD) worldwide. One in 680 adults receive dialysis. The DM prevalence in dialysis patients (60%) is thrice that of the general population. Living donor kidney transplantation in public hospitals has taken place most years since 1992, but the yearly rate remains a minute fraction of that of new dialysis patients. Transplant workup data should be reviewed to assess the impact of DM and to find ways to improve the kidney transplant rate.

Methods:

We retrospectively analysed the transplant workup case notes of all the potential kidney transplant recipients (PKTR) and their potential kidney donors (PKD) that were actively being worked up between 1 August 2022 and 31 July 2024 in all public hospitals in Mauritius as part of the national transplant programme.

Results:

Of 205 donor recipient pairs (DRP) consisting of 165 PKTR and 205 PKD, 34 DRP had ongoing workup.171 DRP completed workup including 30 (17.5%) DRP who proceeded to transplant surgery, 2 DRP (1.2%) awaiting surgery and 139 (81.3%) DRP unsuitable for surgery. Donor, immunological and recipient factors were responsible in 59%, 23% and 16.5% respectively of the cases unsuitable for surgery. Factors include donor DM/pre-diabetes (24.5%) and recipient death during workup (10.8%). Details are shown in Figure 1. Female patients form 34.5% of the dialysis population eligible for transplant, 37% of all PKTR and 43.3% of actual kidney recipients (Table 1). Female donors form 49.8% of all PTD and 53.3% of actual donors. 26 (86.7%) of kidney transplants occurred in Mauritius but 4 (13.3%) complex cases were referred abroad. Table 2 shows that 29.1% of PKTR have DM compared to 45% of the dialysis population eligible for transplant. Only 13.3% of kidney recipients had DM at transplant. There were 99 unsuccessful PKTR with a diabetic rate of 33.3%. Recipient death during workup occurred in 9.1% of unsuitable non-diabetic PTKR and 24.2% of unsuitable diabetic PKTR. The percentage of unsuccessful PKTR with donors who were diagnosed diabetic or pre-diabetic during workup was similar in the non-diabetic and diabetic subgroups (28.8 vs 27.3%). Finally, 17.3% of PKD screened for hyperglycaemia were found to have DM/pre-diabetes. This compares with a combined rate of newly diagnosed DM/pre-diabetes of 21% in the adult Mauritian population < 65 years old in the 2021 Mauritius Non-Communicable Disease Survey.

Conclusions:

In the Mauritius kidney transplant programme, men and women are equally willing to donate and able to access transplantation. The prevalence of newly diagnosed DM and prediabetes in PKD is almost comparable to that of the general population and is a major cause of the high donor dropout. DM prevalence falls significantly from dialysis patients to PKTR and actual transplant recipients. Recipient death during work up is also higher in diabetic PKTR. DM is thus the main obstacle to both kidney donation and eligibility for kidney transplantation. Immunological incompatibility is a close second. Strategies are needed to reduce DM incidence and the subsequent development of CKD in the country. Paired kidney exchange and deceased donor transplant should be considered to expand kidney transplantation in Mauritius.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.