The Impact of Kidney/Pancreas Transplantation on Peripheral Arterial Disease

• Published in: Clinical transplantation Vol. 38; no. 7; pp. e15413 - n/a
• Main Authors: Knight, Richard J., Ye, Yan, Graviss, Edward A., Nguyen, Duc T., Garami, Zsolt, Yi, Stephanie G., Hobeika, Mark, Bavare, Charudatta S., Sadhu, Archana R., Gaber, A. Osama
• Format: Journal Article
• Language: English
• Published: Denmark 01.07.2024
• Subjects: Adult; Carotid Intima-Media Thickness; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - surgery; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic - surgery; Kidney Function Tests; kidney transplantation; Kidney Transplantation - adverse effects; Male; Middle Aged; pancreas transplantation; Pancreas Transplantation - adverse effects; peripheral arterial disease; Peripheral Arterial Disease - etiology; Peripheral Arterial Disease - surgery; Postoperative Complications - epidemiology; Prognosis; Retrospective Studies; Risk Factors; pancreas transplantation; peripheral arterial disease; kidney transplantation
• ISSN: 0902-0063; 1399-0012; 1399-0012
• DOI: 10.1111/ctr.15413

ABSTRACT Introduction It is unclear whether kidney/pancreas (KP) transplantation will prevent the progression of peripheral arterial disease (PAD) in patients with insulin dependent diabetes (IDDM) and end‐stage renal disease. We sought to determine the pre‐ and posttransplant prevalence of symptomatic PAD and changes in carotid artery intima‐media thickness (IMT) in KP recipients. Methods In this single center study, outcomes were compared between KP recipients with and without a history of PAD. A subset of recipients underwent pre‐ and posttransplant IMT measurements. Results Among the study group (N = 107), 18 (17%) recipients admitted to a pretransplant history of symptomatic PAD, comprised 11 foot infections and 7 amputations (5 minor and 2 major). Baseline characteristics of age, gender, race, years of diabetes, dialysis history, smoking history, years of hypertension, and history of coronary artery disease (CAD) were equivalent between PAD and non‐PAD cohorts. At a median follow‐up of 60 months (IQR: 28, 110), 16 (15%) KP recipients had suffered a PAD event. In multivariate analysis, a pretransplant history of PAD (hazard ratio [HR] 9.66, p < 0.001) and CAD (HR 3.33, p = 0.04) were independent predictors of posttransplant PAD events. Among a subset of 20 recipients (3 with PAD), mean IMT measurements pretransplant and at a median of 24 (range 18–24) months posttransplant, showed no evidence of disease progression. Conclusion Based on IMT measurements and clinical results, KP transplantation stabilized PAD in most patients, but did not alter outcomes of symptomatic PAD recipients. A pretransplant history of PAD and CAD was an independent predictor of posttransplant PAD events.