*Purpose: It is unclear whether kidney/pancreas (KP) transplantation will prevent the progression of peripheral vascular disease in patients with IDDM and ESRD. We sought to determine the pre- and post-transplant prevalence of symptomatic PVD and changes in carotid artery intima-media thickness (IMT) in KP recipients.

*Methods: Data was collected via a single center questionnaire study of KP recipients. PVD was defined as a diabetic foot infection requiring hospitalization, an amputation, or a lower extremity revascularization procedure. A subset of recipients underwent measurement of IMT both pre- and post-transplant.

*Results: Demographics of the study group (n=107) included a median and interquartile range (IQR) of 42.0 (35,50) years of age, 64% male, 54% Caucasian, with a median (IQR) of 24 (20, 30) years of diabetes, 15% smokers, and 87% with hypertension pre-transplant. Eighteen (17%) recipients admitted to a pre-transplant history of symptomatic PVD, comprised of 11 foot infections and 7 amputations (5 minor and 2 major). Baseline characteristics of age, gender, race, years of diabetes, dialysis history, smoking history, years of hypertension, and history of coronary artery disease (CAD) were equivalent between PVD and non-PVD cohorts. At most recent follow-up, 17 (16%) KP recipients had suffered a post-transplantation PVD event, consisting of 8 minor and 3 major amputations, 3 foot infections, and 3 revascularization procedures (Figure 1). In multivariate Cox regression analysis, both a pre-transplant history of CAD (hazard ratio [HR] 9.66, p<0.001) and PVD (HR 3.33, p=0.04) were independent predictors of post-transplant PVD events. In a subset of 12 recipients (3 with PVD) a comparison of mean IMT measurements pre-transplant and at a median of 24 (range 18-24) months post-transplant showed no evidence of disease progression (Figure 2).

*Conclusions: Despite stabilization of disease, based on IMT measurements, KP transplantation did not to prevent the progression of PVD complications in recipients with advanced PVD. A pre-transplant history of PVD and CAD were independent predictors of post-transplant PVD events.

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