Objectives:

We aimed to investigate whether receiving a kidney transplant allograft graft increases the risk of ipsilateral lower limb amputation in patients with pre-existing peripheral arterial disease (PAD).

Methods:

We conducted a retrospective review of adult patients with pre-existing PAD who received a kidney transplant at the University of Alberta from 2005 to 2014, using data abstracted from the kidney transplant patient database (OTTR). Exclusion criteria included patients who did not have pre-existing PAD and pediatric patients. The primary outcome was laterality of lower extremity amputation in relation to transplant graft. Baseline demographics and time elapsed from transplant to amputation were also collected. Data were analyzed using a combination of descriptive and comparative statistics.

Results:

A preliminary dataset containing 766 patients who underwent transplantation between 2005 and 2014 was analyzed. 77 patients were identified to have pre-operative PAD. Patients were predominantly male (55:22 M:F) with a mean age at transplant of 56 (31-77). 60/77 (78%) patients were diabetic, 42/77 (55%) patients had known coronary artery disease and 14/77 (18%) patients had a history of stroke. 40/77 (52%) patients had a post-operative amputation. There were significantly more amputations ipsilateral to the transplant graft than contralateral amputations (27/40 vs. 13/40 p=0.0385). There was no significant difference in baseline comorbidities between groups.

Conclusions:

The preliminary data suggests that patients experience a higher rate of lower limb amputation ipsilateral to their transplant allograft. This finding has important implications for patient selection, pre-operative optimization, and post-operative risk modification.

CITATION INFORMATION: Rasmussen A., Moore R., Schuler T., Todd G., Wen K. Kidney Transplantation and Progression of Peripheral Arterial Disease in the Ipsilateral Lower Extremity Am J Transplant. 2017;17 (suppl 3).

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