Introduction: Simultaneous pancreas-kidney transplantation remains the best treatment option in type 1 diabetic patients with chronic kidney failure, providing a euglycemic state associated with an improvement on diabetic chronic complications. However, there are only a few studies addressing the potential ischemic deterioration of peripheral arterial disease, due to blood diverting from the iliac artery to the kidney graft.
Aim: Evaluate diabetic foot lesions and peripheral arterial disease evolution in simultaneous pancreas-kidney transplantation recipients and investigate if they are more frequent in ipsilateral lower limb of kidney graft.
Methodology: A retrospective cohort, including patients submitted to simultaneous pancreas-kidney transplantation inour tertiary center, between 2000 and 2017. Diabetic foot lesions and peripheral arterial disease frequencies were evaluated and then compared in the period before and after transplantation.
Results: Two-hundred and eleven patients were included, being 50.2% (n = 106) female, with a median age at transplantationof 35 years. The median time since diabetes diagnosis was 23 years. The median time under dialysis was 22 months, 68.2% (n = 144) undergoing hemodialysis. The mean HbA1c before the transplantation was 8.6 ± 1.6% and the most recent median was 5.5%. In 2019, the patient, kidney and pancreatic graft survival was 90.5% (n = 191), 83.4% (n = 176) and 74.9% (n = 158), respectively. In the pre-transplant period, 12.3% (n = 26) had peripheral neuropathy, 2.8% (n = 6) had peripheral arterial disease and 5.3 (n = 11) suffered some foot injury. In post-transplant period, 39.3% (n = 83) had peripheral neuropathy, 17.1% (n = 36) peripheral arterial disease and 25.6% (n = 54) developed ulcers, 14 of which in the ipsilateral lower limb of kidney graft, 19 in the contralateral and 21 bilateral (25.9% vs 35.2% vs 38.9%, P = 0.49). Nine patient (4.3%) underwent major amputation, 2 of the ipsilateral limb, 6 of the contralateral and 1 bilateral (22.2% vs 66.7% vs 11.1%, P = 0.09).
Conclusion: Despitesimultaneous pancreas-kidney transplantation positive effects on diabetic chronic complications, we verified a high prevalence of peripheral neuropathy and diabetic foot ulcers in our sample. Diabetic foot lesions were not more frequent in the ipsilateral lower limb of kidney graft, reducing the ‘steal syndrome’ role in these patients.
23 May 2020 - 26 Feb 2020