The Impact of Kidney/Pancreas Transplantation on Peripheral Arterial Disease

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-07-21 DOI:10.1111/ctr.15413

Richard J. Knight, Yan Ye, Edward A. Graviss, Duc T. Nguyen, Zsolt Garami, Stephanie G. Yi, Mark Hobeika, Charudatta S. Bavare, Archana R. Sadhu, A. Osama Gaber

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引用次数: 0

Abstract

Introduction

It is unclear whether kidney/pancreas (KP) transplantation will prevent the progression of peripheral arterial disease (PAD) in patients with insulin dependent diabetes (IDDM) and end-stage renal disease. We sought to determine the pre- and posttransplant prevalence of symptomatic PAD and changes in carotid artery intima-media thickness (IMT) in KP recipients.

Methods

In this single center study, outcomes were compared between KP recipients with and without a history of PAD. A subset of recipients underwent pre- and posttransplant IMT measurements.

Results

Among the study group (N = 107), 18 (17%) recipients admitted to a pretransplant history of symptomatic PAD, comprised 11 foot infections and 7 amputations (5 minor and 2 major). Baseline characteristics of age, gender, race, years of diabetes, dialysis history, smoking history, years of hypertension, and history of coronary artery disease (CAD) were equivalent between PAD and non-PAD cohorts. At a median follow-up of 60 months (IQR: 28, 110), 16 (15%) KP recipients had suffered a PAD event. In multivariate analysis, a pretransplant history of PAD (hazard ratio [HR] 9.66, p < 0.001) and CAD (HR 3.33, p = 0.04) were independent predictors of posttransplant PAD events. Among a subset of 20 recipients (3 with PAD), mean IMT measurements pretransplant and at a median of 24 (range 18–24) months posttransplant, showed no evidence of disease progression.

Conclusion

Based on IMT measurements and clinical results, KP transplantation stabilized PAD in most patients, but did not alter outcomes of symptomatic PAD recipients. A pretransplant history of PAD and CAD was an independent predictor of posttransplant PAD events.

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肾/胰移植对外周动脉疾病的影响。

导言：目前尚不清楚肾/胰（KP）移植是否能预防胰岛素依赖型糖尿病（IDDM）和终末期肾病患者外周动脉疾病（PAD）的恶化。我们试图确定 KP 受者移植前后无症状 PAD 的患病率以及颈动脉内膜中层厚度（IMT）的变化：在这项单中心研究中，对有 PAD 病史和无 PAD 病史的 KP 受者的结果进行了比较。一部分受者接受了移植前后的内膜中层厚度测量：在研究组（N = 107）中，有 18 名受者（17%）在移植前有症状性 PAD 病史，其中包括 11 例足部感染和 7 例截肢（5 例轻微截肢和 2 例严重截肢）。PAD组和非PAD组的年龄、性别、种族、糖尿病年限、透析史、吸烟史、高血压年限和冠状动脉疾病（CAD）史等基线特征相同。中位随访时间为 60 个月（IQR：28 至 110 个月），有 16 名（15%）KP 患者发生了 PAD 事件。在多变量分析中，移植前PAD病史（危险比[HR] 9.66，p < 0.001）和CAD（HR 3.33，p = 0.04）是移植后PAD事件的独立预测因素。在20名受者（3名患有PAD）中，移植前和移植后24个月（18-24个月）的平均IMT测量结果显示没有疾病进展的迹象：根据IMT测量结果和临床结果，KP移植可稳定大多数患者的PAD，但不会改变无症状PAD受者的预后。移植前的PAD和CAD病史是移植后PAD事件的独立预测因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.