Should peripheral vascular disease- or diabetes-related amputation contraindicate renal transplant?

This study investigates whether end-stage renal disease (ESRD) patients with amputation secondary to peripheral vascular disease (PVD) or diabetes mellitus (DM) are appropriate candidates for renal transplant. Limb- or digit- amputees with ESRD on the renal transplant list from 1993-2008 were included. Comorbidities, amputation type, duration on the waitlist, and current transplant status were analyzed. Additionally, US renal transplant centers were surveyed regarding their views about amputees' transplant candidacy. Thirty-eight ESRD patients with amputations were identified; 3 patients underwent renal transplant, 14 expired on the waitlist, and 14 were removed for medical reasons. The survey indicated that centers generally don't consider amputation a contraindication to transplant listing. Few ESRD patients with amputations who are placed on the transplant list undergo renal transplant; most die or are removed for medical reasons. Amputation should be considered an indicator of severe PVD and possibly a relative contraindication to listing for renal transplant.