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. 2024 Jul;38(7):e15413.
doi: 10.1111/ctr.15413.

The Impact of Kidney/Pancreas Transplantation on Peripheral Arterial Disease

Richard J Knight  1 , Yan Ye  2 , Edward A Graviss  1   3 , Duc T Nguyen  4 , Zsolt Garami  5 , Stephanie G Yi  1 , Mark Hobeika  1 , Charudatta S Bavare  5 , Archana R Sadhu  6 , A Osama Gaber  1
Affiliations

The Impact of Kidney/Pancreas Transplantation on Peripheral Arterial Disease

Richard J Knight et al. Clin Transplant. 2024 Jul.

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.

Keywords: kidney transplantation; pancreas transplantation; peripheral arterial disease.

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