Long-term Lower Extremity and Cardiovascular Complications after Simultaneous Pancreas-Kidney Transplant.
Dominic AmaraHillary J BraunAmy M ShuiThomas SorrentinoJoel L RamirezJoseph LinIris H LiuAnna MelloPeter G StockJade S HiramotoPublished in: Clinical transplantation (2021)
Lower extremity (LE) vascular disease and adverse cardiovascular events (ACEs) cause significant long-term morbidity after simultaneous pancreas-kidney (SPK) transplantation. This study's purpose was to describe the incidence of, and risk factors associated with, LE vascular complications and related ACEs following SPK. All SPKs performed at the authors' institution from 2000 to 2019 were retrospectively analyzed. The primary outcome was any LE vascular event, defined as LE endovascular intervention, open surgery, amputation, or invasive podiatry intervention. Secondary outcomes included post-SPK ACE. A total of 363 patients were included, of whom 54 (14.9%) required at least one LE vascular intervention following SPK. Only 3 patients received pre-SPK ankle brachial indices (ABIs). A history of peripheral artery disease (PAD) (HR 2.95, CI 1.4-6.2) was a risk factor for post-SPK LE vascular intervention even after adjustment for other factors. Fifty-nine (16.3%) patients experienced an ACE in follow-up. Requiring a LE intervention post-SPK was associated with a subsequent ACE (HR 2.3, CI 1.2-4.5). LE vascular and cardiovascular complications continue to be significant sources of morbidity for SPK patients, especially for patients with preexisting PAD. The highest risk patients may benefit from more intensive pre- and post-SPK workup with ABIs and follow-up with a vascular surgeon.
Keyphrases
- end stage renal disease
- randomized controlled trial
- newly diagnosed
- ejection fraction
- cardiovascular events
- emergency department
- adipose tissue
- stem cells
- patient reported outcomes
- minimally invasive
- cardiovascular disease
- risk factors
- metabolic syndrome
- coronary artery bypass
- acute coronary syndrome
- weight loss
- drinking water
- surgical site infection
- electronic health record
- aortic dissection