Abstract
BackgroundPatients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. We aimed to investigate the feasibility of preoperative screening for peripheral arterial disease (PAD), specifically ankle-brachial index (ABI) testing, to predict peri- and postoperative outcomes in SPKT recipients.MethodsMedical data (2000–2016) from all patients with IDDM and ESKD undergoing SPKT at our transplant center were retrospectively analyzed. The correlation between PAD (defined by an abnormal ABI before SPKT and graft failure and mortality rates as primary end points, and the occurrence of acute myocardial infarction, cerebrovascular and peripheral vascular complications as secondary end points were investigated after adjustment for known cardiovascular risk factors.ResultsAmong 101 SPKT recipients in our transplant population who underwent structured physiological arterial studies, 17 patients (17%) were diagnosed with PAD before transplantation. PAD, as defined by a low ABI index, was an independent and significant predictor of death (HR, 2.99 (95% CI 1.00–8.87), p = 0.049) and pancreas graft failure (HR, 4.3 (95% CI 1.24–14.91), p = 0.022). No significant differences were observed for kidney graft failure (HR 1.85 (95% CI 0.76–4.50), p = 0.178). In terms of the secondary outcomes, patients with PAD were more likely to have myocardial infarction, stroke, limb ischemia, gangrene or amputation (HR, 2.90 (95% CI 1.19–7.04), p = 0.019).ConclusionsPre-transplant screening for PAD and cardiovascular risk factors with non-invasive ABI testing may help to reduce perioperative complications in high-risk patients. Future research on long-term outcomes might provide more in depth insights in optimal treatment strategies for PAD among SPKT recipients.
Highlights
Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality
We found that peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), was an independent and significant predictor and risk factor of death (HR, 2.99, p = 0.049) and pancreatic allograft failure (HR, 4.3, p = 0.022)
In conclusion, we demonstrated that ABI evaluation combined with toe−brachial index (TBI) testing in unclear cases is a valuable, inexpensive and feasible assessment tool for accurate examination of perioperative cardiovascular risk in patients undergoing SPKT
Summary
Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. Simultaneous pancreas kidney transplantation (SPKT) represents the “state of the art” treatment modality for patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) [1]. In recent years, increasing evidence has indicated that peripheral arterial disease (PAD) is a major healthcare burden and is highly prevalent among patients with IDDM and ESKD, as compared with the general population [2, 3]. Patients with PAD have a three- to fivefold increased risk of adverse outcomes of cardiovascular and cerebrovascular morbidity and mortality, including myocardial infarction (MI), stroke and mortality associated with coronary artery disease (CAD) [7, 8].
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