*Purpose: Type 1 diabetes mellitus (DM) is the leading indication for simultaneous pancreas kidney transplantation (SPK). Prior work has demonstrated a 2% incidence of lower extremity (LE) vascular complications in kidney recipients, and a 5-23% incidence in SPK recipients, yet there is no standard vascular evaluation or follow up for these patients. The purpose of this study was to describe the incidence and risk factors for LE vascular complications following SPK at a single United States transplant center.

*Methods: A retrospective review of all patients who underwent SPK at our institution between 2000-2019 was performed. Patients were excluded for age<18 or prior pancreas transplant. Baseline demographics, comorbidities, transplant details, medications, and vascular complication data were collected from the electronic medical record (EMR), and analyzed using t-tests and Fisher’s exact tests where appropriate. Significance was set at p<0.05.

*Results: 373 patients were included, of whom 52 (14%) required at least one LE intervention following SPK (Table 1). A total of 75 interventions were performed in this cohort: 16 endoluminal revascularization procedures, 2 open bypass grafts, 36 amputations, and 21 podiatry. Only 3 patients (0.8%) had pre-transplant ankle brachial indices (ABIs). Patients who required LE intervention after SPK were more often African American (21.2% vs. 11.2%, p=0.08), had more frequent LE interventions prior to SPK (13.5% vs. 4.7%, p=0.02), and had a higher prevalence of pre-transplant peripheral artery disease as documented in the EMR (11.5% vs. 3.1%, p=0.01). Notably, the incidence of adverse cardiac events after SPK (composite of myocardial infarction, percutaneous coronary intervention, coronary artery bypass, and cerebrovascular accident) was higher in patients who required LE intervention (23.1% vs. 7.5%, p=0.05).

*Conclusions: LE vascular complications after SPK are a major source of morbidity and are associated with a higher incidence of adverse cardiac events. While SPK restores pancreas and renal function, these patients still appear to be at ongoing risk for LE vascular complications. Strong consideration should be given to pre-operative non-invasive arterial evaluation and close follow-up with a vascular provider.

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