The influence of simultaneous pancreas–kidney transplantation on the evolution of diabetic foot lesions and peripheral arterial disease

• Published in: Journal of endocrinological investigation 2023-07, Vol.46 (7), p.1459-1464
• Main Authors: Monteiro, S. S., Santos, T. S., Pereira, C. A., Duarte, D. B., Neto, H., Gomes, A., Loureiro, L., Martins, J., Silva, F., Martins, L. S., Ferreira, L., Amaral, C., Freitas, C., Carvalho, A. C., Carvalho, R., Dores, J.
• Format: Article
• Language: English
• Subjects: Amputation; Diabetes; Diabetes mellitus (insulin dependent); Endocrinology; Feet; Foot diseases; Internal Medicine; Ischemia; Kidney transplantation; Kidney transplants; Lesions; Medicine; Medicine & Public Health; Metabolic Diseases; Original Article; Pancreas transplantation; Renal failure; Ulcers
• ISSN: 1720-8386; 0391-4097; 1720-8386
• DOI: 10.1007/s40618-023-02009-3

Purpose Simultaneous pancreas–kidney transplantation (SPKT) remains the best treatment option in patients with type 1 diabetes and chronic kidney failure. There are only a few studies addressing the potential ischemic deterioration of peripheral arterial disease (PAD) due to blood diverting from the iliac artery to the kidney graft. We aimed to evaluate diabetic foot lesions and PAD evolution in SPKT recipients and investigate if they are more frequent in ipsilateral lower limb of kidney graft. Methods We developed a retrospective cohort, including patients submitted to SPKT in our tertiary center, between 2000 and 2017. Diabetic foot lesions and PAD frequencies were compared in the period before and after transplantation. Results Two hundred and eleven patients were included, 50.2% ( n  = 106) female, with a median age at transplantation of 35 years (IQR 9). After a median follow-up period of 10 years (IQR 7), patient, kidney, and pancreatic graft survival were 90.5% ( n  = 191), 83.4% ( n  = 176), and 74.9% ( n  = 158), respectively. Before transplant, 2.8% ( n  = 6) had PAD and 5.3% ( n  = 11) had history of foot lesions. In post-transplant period, 17.1% ( n  = 36) patients presented PAD and 25.6% ( n  = 54) developed diabetic foot ulcers, 47.6% ( n  = 35) of which in the ipsilateral and 53.3% ( n  = 40) in the contralateral lower limb of the kidney graft ( p  = 0.48). Nine patients (4.3%) underwent major lower limb amputation, 3 (30%) ipsilateral and 7 (70%) contralateral to the kidney graft ( p  = 0.29). Conclusions Diabetic foot lesions were not more frequent in the ipsilateral lower limb of the kidney graft, therefore downgrading the ‘steal syndrome’ role in these patients.