Acute diabetic foot in post kidney transplantation patients receiving chronic immunosuppression-clinical presentation and outcomes.

Abstract

Data regarding diabetic foot ulcers in patients after solid organ transplantation, particularly kidney transplantation, are limited. Chronic immunosuppression may be associated with impaired wound healing and a higher risk of amputations. In this study, we characterised the clinical presentation and outcomes of patients after kidney transplantation admitted to the diabetic foot unit, compared to non-kidney-transplant patients. Data on the baseline characteristics, clinical presentation, and outcomes of all patients admitted to the diabetic foot unit of a large tertiary centre between the years 2014 and 2019 were collected. The most recent admission of each patient was considered. Primary outcomes were major amputations and 1year mortality rate. During the study period, 537 patients were hospitalised, 18 of them were receiving immunosuppressive therapy due to kidney transplantation. Baseline characteristics of the patients were broadly similar, except that smoking was reported by 22.0% of the non-transplant patients and by none of the post-transplant patients (p=0.01). Post-transplant patients tended to be younger (59.4±11.1 vs. 65.3±12.2; p=0.07), were more likely to have type-1 diabetes (16.7% vs. 5.2%; p=0.07) and had lower glucose levels upon admission (9.4±4.3 vs. 12.0±6.4mmol/L; p=0.07). Overall, 30% of the patients underwent major amputation, in-patient mortality rate was 9.3%, and 1year mortality rate was 27.2%. Rates were similar in the post-transplant versus the non-post-transplant patients (p=0.83, 1.00, 0.59, respectively). Post-transplant patients did not incur worse outcomes in spite of immunosuppressive therapy. Limb salvage efforts should be pursued in these patients similar to the overall population.