*Purpose: Japan substantially outperforms other countries in survival of patients receiving haemodialysis (HD). Unadjusted 5-year survival was 60% in Japan, 39% in the USA, and 41% in Europe for patients starting dialysis in 2004-08 (Robinson BM, et al. Lancet 2016). On the other hand, it has not been reported that the significance of kidney transplantation (KTx) on life prognosis compared with HD in Japan until now. To evaluate the availability of KTx for the prevention of aggravation of peripheral arterial disease (PAD) in the ischemic lower limb on the patient with diabetes in Japan, a multicenter retrospective cohort study was performed.

*Methods: The patients who underwent living donor KTx (LDKTx) due to diabetic end stage kidney disease in 2011-13 at ten sites in Japan (LDKTx group, n=152), and the diabetic patient who underwent HD in the same periods (HD group, n=192) were enrolled in the study. Univariate and multivariate analysis were performed to identify the risks of PAD and life prognosis until 2016 in selected cases matched by propensity score.

*Results: Concerning the frequency of PAD treatment and the all cause’s mortality rate, there was no significant difference between LDKTx group and HD group in univariate analysis. However, LDKTx is significant factor for decreasing the frequency of PAD treatment (p=0.030) and the risk of all cause’s mortality (p=0.047) in multivariate analysis. Moreover, LDKTx significantly decreased the risk of the mortality due to cardiovascular and cerebrovascular disease, compared with HD in both univariate and multivariate analysis (p=0.039, 0.045).

*Conclusions: Living donor kidney transplantation prevents the aggravation of peripheral arterial disease in the ischemic lower limb, and decreases the mortality due to arterial sclerosis, resulting in contribution for life prognosis on the patients with diabetes in Japan.

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