*Purpose: Aortoiliac vascular disease (AVD) is frequently observed during the work-up for kidney transplantation, but recommendations on its screening and management are lacking. We aimed to assess differences in screening, management and acceptance of these patients for transplantation by performing an international survey among transplant surgeons. Secondly, we aimed to identify center- and surgeon-related factors associated with either declining or accepting kidney transplant candidates with AVD.

*Methods: A survey was sent to transplant surgeons worldwide. The survey contained general questions and 2 patient-based cases with Trans-Atlantic Inter-Society Consensus (TASC) D and B AVD supported with videos of their CT-scans.

*Results: 191 (20.3%) potential participants responded; 171 were currently involved in kidney transplantation; 145 (84.8%) completed the survey. Screening for AVD was mostly (37.2%) restricted to high-risk patients. Pre-transplantation vascular interventions were infrequently performed (71.7% mentioned <10 per year). If needed, 67.5% would perform an open vascular intervention before transplantation and 32.5% simultaneously. The likelihood to decline a patient for transplantation was higher in the TASC D case compared to TASC B (26.9% and 9.7%). Respondents from centers with expertise in pretransplant vascular interventions were more likely to accept both patients with TASC D and B for transplantation.

*Conclusions: Heterogeneity exists concerning management of transplant candidates with AVD. A multidisciplinary meeting where technical feasibility and comorbidity are discussed could aid in providing equal access to transplantation. Referral to centers with experience in pretransplant vascular procedures may increase the chance of acceptance of patients with AVD for transplantation.

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