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. 2022 May 29;14(5):e25455.
doi: 10.7759/cureus.25455. eCollection 2022 May.

Rate of Ipsilateral Chronic Limb-Threatening Ischemia (CLTI) After Kidney Transplantation: A Retrospective Single-Center Study

Abdul Kader Natour  1 , Ziad Al Adas  1 , Timothy Nypaver  1 , Alexander Shepard  1 , Mitchell Weaver  1 , Lauren Malinzak  2 , Anita Patel  3 , Loay Kabbani  1
Affiliations

Rate of Ipsilateral Chronic Limb-Threatening Ischemia (CLTI) After Kidney Transplantation: A Retrospective Single-Center Study

Abdul Kader Natour et al. Cureus. .

Abstract

Objective: To analyze whether the rate of lower extremity (LE) ischemia is higher on the ipsilateral side after kidney transplantation.

Methods: Our institutional transplant database was retrospectively queried for all patients who received a kidney transplant and underwent subsequent LE revascularization or major limb amputations between January 2004 and July 2020. The one-sample binomial test was used to test whether the LE ipsilateral to the transplanted kidney was at higher risk of peripheral arterial disease (PAD) complications necessitating intervention (major amputation or revascularization).

Results: There were 1,964 patients who received a kidney transplant during the study period. Of these, 51 patients (3%) had subsequent LE arterial revascularizations or major amputations. The mean age was 58 ± 10 years, and 37 patients (73%) were male. A total of 33 patients had ipsilateral LE vascular interventions (26 major amputations and seven revascularizations) while 18 patients had contralateral vascular interventions (14 major amputations and four revascularizations) (P = 0.049). The average interval between transplantation and subsequent vascular intervention was 52 months for the ipsilateral intervention group and 41 months for the contralateral intervention group (P = 0.33).

Conclusions: In patients who received kidney transplantation and required subsequent LE surgical intervention, we observed an association between the side of transplantation and the risk of future ipsilateral LE arterial insufficiency. Further studies are needed to determine the etiology of this association.

Keywords: chronic limb threatening ischemia; end-stage renal disease; kidney transplantation; lower extremity revascularization; peripheral artery disease.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Patient exclusion algorithm
PAD: peripheral arterial disease
Figure 2
Figure 2. Comparison between ipsilateral and contralateral amputations and revascularizations using the one sample binomial test
See this image and copyright information in PMC

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