Histopathologic Remission of Severe Diabetic Nephropathy of Donor Kidney After Kidney Transplantation: A Case Report.

Although diabetes is not an absolute contraindication for kidney donation, donor kidneys with severe diabetic nephropathy (DN) are frequently discarded. Current experience with the use of donor kidneys with severe DN is limited. Herein, we report a case of deceased donor kidney with Renal Pathology Society (RPS) classification scheme class III DN transplanted to a female recipient without postoperative hyperglycemia. Although kidney allograft biopsy still showed class III DN at 6 months, it turned to RPS class IIa DN combined with chronic antibody-mediated rejection at 4.5 years and 9 years. At the last follow-up approximately 10 years after transplantation, the patient's serum creatinine was 2.27 mg/dL. Our case indicates that with careful selection of potential recipients, favorable clinical outcomes can be achieved even with donor kidneys with severe DN. Thus, RPS class III diabetic donor kidneys deserve further evaluation and should not always be discarded.