The American Society of Transplantation

It is difficult to predict who will develop diabetes. Gestational diabetes along with obesity, ethnicity and family history are all risk factors for development of mature onset diabetes. Better tests are needed but the most predictive available tests are the fasting blood glucose, insulin levels, and the 2 hour glucose tolerance test. In one study 35% of women who have gestational diabetes developed type 2 diabetes by 15 years after delivery.(ref 1) A study of 241 diet treated women with GDM diagnosed between 1978 - 85 in Copenhagen found that 2-11 years later 34% had abnormal glucose (3.7% IDDM, 13.7% NIDDM, 17%IGT) in contrast to a control group where none had diabetes and 5.3% had IGT.(ref 2) So clearly there is a risk. Importantly diet, excercise can modify this risk. We therefore do not exclude patients simply on the basis of GDM but alo look at their current risk based on BMI at time of evaluation, and laboratories (fasting glucose and oral glucose tolerance). The next question is what if the donor does develop diabetes. The existing data would suggest that the risk of micro and macro-albuminuria are increased. One of the most widely known studies is that of Silveiro (ref 3). Importantly microalbuminuria was noted an average of 23 years after nephrectomy, but was present as soon as five years after nephrectomy. The conclusions that can be drawn are that nephrectomy in an individual with diabetes, normal renal function and no dipstick identifiable proteinuria is likely not going to cause problems in the short term. However with time increasing proteinuria is common, and this may ultimately lead to loss of renal function and perhaps an increase in cardiovascular disease. Putting all of this together - the key considerations are the age of your donor and an assessment of their current risk based on BMI and laboratory tests. If they are young, the risk may preclude donation, if they are older and their other risk factors are low - this may be acceptable with informed consent. 1)Linne Y et al. Br J obst and Gyne 58:193-200, 2002 2)Damm P. Dan Med Bull. 1998 Nov;45(5)495-509 3)Silviero Diabetes Care 21: 1521-24, 1998. John Gill, MD, MS University Of British Columbia St. Paul's Hospital Member, AST Education Committee