Peripheral arterial disease as a predictor of outcome after renal transplantation

Our aim was to assess the prevalence of symptomatic and asymptomatic peripheral occlusive arterial disease (POAD) in 129 consecutive diabetic (n = 34) and nondiabetic (n = 95) patients undergoing renal transplantation. The association of pre-existent POAD and complaints of claudication, lower limb amputations, and graft and patient survival were evaluated during a 5-year follow up. A questionnaire on walking capacity, ankle/brachial (ABI) and toe/brachial (TBI) pressure indices as well as the pulse volume recording (PVR) at the ankle were used to assess resting haemodynamics and the presence of POAD 4 days after the transplantation. Unquestionable ischaemia was encountered in 5 (4%) patients all with a history of intermittent claudication and an ABI equal or below 0.77. While using assessment methods not affected by vessel calcification, i.e. toe pressures and PVR damping, a many-fold frequency of arterial disease was observed when compared to previous studies. TBI below 0.65 was found in 11 of diabetic (32%) and in 15 of the others (16%), and a PVR amplitude below 5 min in 28 of diabetics (82%) and in 34 of non-diabetics (36%). During the 5-year follow up, abnormal TBI and PVR values and diabetes at the time of transplantation were the greatest risk factors for proximal foot amputations. The low TBI levels also indicated a shortened patient survival. However, transplant function was not affected by the presence of abnormal haemodynamic indices at the time of transplantation.