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

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Abstract

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.

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Data availability statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Abbreviations

ESRD:

End-stage renal disease

IQR:

Interquartile range

PAD:

Peripheral arterial disease

SPKT:

Simultaneous pancreas–kidney transplantation

T1DM:

Type 1 diabetes mellitus

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Acknowledgements

We acknowledge contribution and support from Luís Costa, Miguel Abreu, Pedro Cantista, Rosa Guimarães, Joel Pereira, Sara Pinto, and other members of Diabetic Foot Unit-Centro Hospitalar Universitário do Porto. This work has previously been partially presented as an electronic poster in the 22nd European Congress of Endocrinology in 2020 and the corresponding summary can be found on https://doi.org/10.1530/endoabs.70.AEP274

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal

    S. S. Monteiro, T. S. Santos, C. A. Pereira, D. B. Duarte, L. Ferreira, C. Amaral, C. Freitas, A. C. Carvalho, R. Carvalho & J. Dores

  2. Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal

    H. Neto, A. Gomes, L. Loureiro, J. Martins, L. Ferreira, C. Amaral, C. Freitas, A. C. Carvalho & R. Carvalho

  3. Division of Nephrology and Transplant, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal

    F. Silva & L. S. Martins

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  1. S. S. Monteiro
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Contributions

SSM and JD designed the study. SSM, TSS, CAP, DBD, and FS acquired the data. SSM, TSS, ACC, and JD interpreted the data. SSM and TSS drafted the work and all authors revised it critically for important intellectual content. All authors approved the final version submitted and are accountable for all aspects of the work. All authors read and approved the final manuscript.

Corresponding author

Correspondence to S. S. Monteiro.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the local Ethics Committee (250-DEFI/267-CES). Consent to participate was waived by the Ethics Committee due to the retrospective nature of the study and full data anonymization.

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For this type of study, no informed consent is required.

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Monteiro, S.S., Santos, T.S., Pereira, C.A. et al. The influence of simultaneous pancreas–kidney transplantation on the evolution of diabetic foot lesions and peripheral arterial disease. J Endocrinol Invest 46, 1459–1464 (2023). https://doi.org/10.1007/s40618-023-02009-3

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