Survival Benefit of Deceased Donor Kidney Transplantation among Patients with Peripheral Artery Disease

Peripheral artery disease (PAD) is a common comorbidity among patients waitlisted for deceased donor kidney transplant (DDKT). However, some centers consider PAD a contraindication for transplant given the higher risk of postoperative complications. We aimed to examine the survival benefit of DDKT among patients with and without PAD.

We used data from the Scientific Registry of Transplant Recipients (SRTR) from January 2003 to December 2022 to identify all DDKT waitlist candidates. Kaplan-Meier survival estimates and multivariable Cox proportional hazards models were used to compare patient mortality for those who received a DDKT versus those remaining on the waitlist, stratified by PAD status.

Overall, 506,785 candidates were listed for adult kidney-only transplant during the study period, of which 8.7% had PAD and 36.0% received a DDKT. After a median follow-up time of 3.21 years from waitlist activation [interquartile range 1.11-7.03 years], mortality varied significantly according to DDKT and PAD status. After adjusting for baseline differences, DDKT was associated with a significantly lower hazard of death compared to remaining on the waitlist, regardless of PAD status [adjusted hazards ratio 0.45-0.60, P < 0.001]. Further stratifying by sex, race and ethnicity, and diabetes status did not substantially alter these results.

PAD includes a spectrum of diseases with varying mortality risks. As captured and dichotomized in the SRTR database, DDKT conferred a similar long-term benefit relative to remaining on the waitlist for candidates with and without PAD. Therefore, PAD should not be an absolute contraindication to DDKT.