Introduction: There is lack of information whether waitlisted dialysis patients with peripheral vascular disease (PVD) benefit from kidney transplantation.

Methods: We used a cohort of USRDS incident dialysis patients from 2001 to 2007, with follow-up through 2008. Patients with PVD under the age of 70 were included and divided into three groups; PVD patients on dialysis, waitlisted and PVD patients who received a first transplant. Standardized Mortality Ratios (SMR) and hazard ratios of death were calculated for statistical comparisons between the 3 groups. Time-dependent Cox regression models were used to compare mortality between waitlisted and transplanted patients.

Results: 23,699 incident dialysis patients met inclusion criteria; only 16.7% (n=3964) were waitlisted, of which 8.9 % (n=2,121) were transplanted. The annual death rates per 100 patient years was 22.86 in PVD patients on dialysis, 4.98 in waitlisted PVD patients and 4.86 in kidney transplant recipients. Using time-dependent Cox regression, there was no significant difference in mortality between transplanted and waitlisted patients in first 100 days after living donor transplantation (RR= 0.92, 95% Confidence Interval [C.I.] 0.50 to 1.69, p = 0.78). However there was a significantly lower risk of mortality compared to waitlisted patients in the two periods: 101days to 1 year (RR= 0.31, 95% C.I. 0.16 to 0.61, p=0.001) and longer than 1 year post transplantation (RR= 0.34, 95% C.I. 0.21 to 0.55, p=0.001). The benefit of deceased donor kidney transplantation over being on waitlist was not observed at any time point.

Conclusions: There was no survival advantage of deceased donor renal transplantation compared to remaining on the waitlist in PVD patients.

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