*Purpose: Sub-inguinal bypass with cold-stored saphenous vein allograft is a last option treatment for extensive peripheral arterial occlusive disease with absent autologous vein. The aim was retrospective evaluation in patients after organ transplant who are on intensive immunosuppression.

*Methods: Nineteen bypasses were implanted in 15 patients at mean age 64±9 (51-80) years in between 2004-18. Mean SVS comorbidity score was 12.5±1.9 points. Leg ischemia were Rutherford class 4 (rest pain, n=3), class 5 (tissue loss, n=10) and class 6 (major tissue loss, n=6). Mean time after organ transplant was 7.3±4.8 (0.8-16.1) years. Organs transplanted were: kidney (n=6), heart (n=4), heart + kidney (n=1), liver (n=1) and pancreas + kidney (n=3). Fourteen bypasses were on single and 5 were on dual antithrombotic therapy. Dual or triple immune suppression was 13× tacrolimus-, 5× cyclosporin- and 1× sirolimus-based. The results were compared to a non-transplant historical control obtaining tacrolimus monotherapy only (n=81, 2009-2013). Data were analyzed by Kaplan Meier survival analysis.

*Results: Technical success was 100%. Surgical complications were (3/19): wound dehiscence, bowel perforation, early thrombectomy. There was no early mortality or amputation. At 1, 2 and 3 years the primary patency was 24%, 0% and 0% (control: 27%, 19% and 14%, n.s.), and the secondary patency was 42%, 31% and 0% (control: 71%, 71% and 57%, n.s.), respectively. The noticeable differences were non-significant probably due to low numbers. Limb salvage was 81%, 67% and 54% (control: 80%, 73% and 64%, n.s.), respectively. Survival of the transplant patients at 1, 3 and 5 years was 88%, 80% and 68%, and amputation-free survival was 69%, 40% and 27%, respectively.

*Conclusions: Vein allograft bypasses generally show low patency but reasonable limb salvage. In transplant population, they achieve numerically even lower patency but similar limb salvage. This is probably due to severe morbidity of the transplant population with critical ischemia that may outweigh the effect of intense immune suppression on allograft patency.

Supported by Ministry of Health of the Czech Republic, grant nr. 18-02-00422

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