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. 2021 Mar;35(3):e14195.
doi: 10.1111/ctr.14195. Epub 2021 Jan 11.

Long-term Lower Extremity and Cardiovascular Complications after Simultaneous Pancreas-Kidney Transplant

Dominic Amara  1 , Hillary J Braun  2 , Amy M Shui  3 , Thomas Sorrentino  2 , Joel L Ramirez  2 , Joseph Lin  2 , Iris H Liu  1 , Anna Mello  2 , Peter G Stock  2 , Jade S Hiramoto  2
Affiliations

Long-term Lower Extremity and Cardiovascular Complications after Simultaneous Pancreas-Kidney Transplant

Dominic Amara et al. Clin Transplant. 2021 Mar.

Abstract

Lower extremity (LE) vascular disease and adverse cardiovascular events (ACEs) cause significant long-term morbidity after simultaneous pancreas-kidney (SPK) transplantation. This study's purpose was to describe the incidence of, and risk factors associated with, LE vascular complications and related ACEs following SPK. All SPKs performed at the authors' institution from 2000 to 2019 were retrospectively analyzed. The primary outcome was any LE vascular event, defined as LE endovascular intervention, open surgery, amputation, or invasive podiatry intervention. Secondary outcomes included post-SPK ACE. A total of 363 patients were included, of whom 54 (14.9%) required at least one LE vascular intervention following SPK. Only 3 patients received pre-SPK ankle brachial indices (ABIs). A history of peripheral artery disease (PAD) (HR 2.95, CI 1.4-6.2) was a risk factor for post-SPK LE vascular intervention even after adjustment for other factors. Fifty-nine (16.3%) patients experienced an ACE in follow-up. Requiring a LE intervention post-SPK was associated with a subsequent ACE (HR 2.3, CI 1.2-4.5). LE vascular and cardiovascular complications continue to be significant sources of morbidity for SPK patients, especially for patients with preexisting PAD. The highest risk patients may benefit from more intensive pre- and post-SPK workup with ABIs and follow-up with a vascular surgeon.

Keywords: cardiovascular disease; peripheral artery disease; simultaneous pancreas-kidney transplantation; type 1 diabetes; vasculopathy.

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References

REFERENCES

    1. MacCraith E, Davis NF, Browne C, Mohan P, Hickey D. Simultaneous pancreas and kidney transplantation: incidence and risk factors for amputation after 10-year follow-up. Clin Trans. 2017;31(6):e12976.
    1. Sucher R, Rademacher S, Jahn N, et al. Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases. BMC Nephrol. 2019;20(1):453.
    1. Surowiecka-Pastewka A, Matejak-Gorska M, Fraczek M, Sklinda K, Walecki J, Durlik M. Endovascular interventions in vascular complications after simultaneous pancreas and kidney transplantations: a single-center experience. Ann Transplant. 2019;24:199-207.
    1. Woeste G, Wullstein C, Pridohl O, et al. Incidence of minor and major amputations after pancreas/kidney transplantation. Transpl Int. 2003;16(2):128-132.
    1. Norden G, Carlstrom J, Wramner L, Nyberg G. Macrovascular disease after simultaneous pancreas and kidney transplantation. Clin Transplant. 2004;18(4):372-376.

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