Hans-Michael Hau1,2,3, Nora Jahn4, Max Brunotte5, Tristan Wagner5, Sebastian Rademacher5, Daniela Branzan5, Elisabeth Sucher5, Daniel Seehofer5, Robert Sucher5. 1. Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany. Hans-Michael.Hau@uniklinikum-dresden.de. 2. Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Hans-Michael.Hau@uniklinikum-dresden.de. 3. Department of Surgery, University Hospital of Dresden, Fetscherstrasse 74, 03107, Dresden, Germany. Hans-Michael.Hau@uniklinikum-dresden.de. 4. Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany. 5. Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany.
Abstract
BACKGROUND: Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. We aimed to investigate the feasibility of preoperative screening for peripheral arterial disease (PAD), specifically ankle-brachial index (ABI) testing, to predict peri- and postoperative outcomes in SPKT recipients. METHODS: Medical data (2000-2016) from all patients with IDDM and ESKD undergoing SPKT at our transplant center were retrospectively analyzed. The correlation between PAD (defined by an abnormal ABI before SPKT and graft failure and mortality rates as primary end points, and the occurrence of acute myocardial infarction, cerebrovascular and peripheral vascular complications as secondary end points were investigated after adjustment for known cardiovascular risk factors. RESULTS: Among 101 SPKT recipients in our transplant population who underwent structured physiological arterial studies, 17 patients (17%) were diagnosed with PAD before transplantation. PAD, as defined by a low ABI index, was an independent and significant predictor of death (HR, 2.99 (95% CI 1.00-8.87), p = 0.049) and pancreas graft failure (HR, 4.3 (95% CI 1.24-14.91), p = 0.022). No significant differences were observed for kidney graft failure (HR 1.85 (95% CI 0.76-4.50), p = 0.178). In terms of the secondary outcomes, patients with PAD were more likely to have myocardial infarction, stroke, limb ischemia, gangrene or amputation (HR, 2.90 (95% CI 1.19-7.04), p = 0.019). CONCLUSIONS: Pre-transplant screening for PAD and cardiovascular risk factors with non-invasive ABI testing may help to reduce perioperative complications in high-risk patients. Future research on long-term outcomes might provide more in depth insights in optimal treatment strategies for PAD among SPKT recipients.
BACKGROUND:Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. We aimed to investigate the feasibility of preoperative screening for peripheral arterial disease (PAD), specifically ankle-brachial index (ABI) testing, to predict peri- and postoperative outcomes in SPKT recipients. METHODS: Medical data (2000-2016) from all patients with IDDM and ESKD undergoing SPKT at our transplant center were retrospectively analyzed. The correlation between PAD (defined by an abnormal ABI before SPKT and graft failure and mortality rates as primary end points, and the occurrence of acute myocardial infarction, cerebrovascular and peripheral vascular complications as secondary end points were investigated after adjustment for known cardiovascular risk factors. RESULTS: Among 101 SPKT recipients in our transplant population who underwent structured physiological arterial studies, 17 patients (17%) were diagnosed with PAD before transplantation. PAD, as defined by a low ABI index, was an independent and significant predictor of death (HR, 2.99 (95% CI 1.00-8.87), p = 0.049) and pancreas graft failure (HR, 4.3 (95% CI 1.24-14.91), p = 0.022). No significant differences were observed for kidney graft failure (HR 1.85 (95% CI 0.76-4.50), p = 0.178). In terms of the secondary outcomes, patients with PAD were more likely to have myocardial infarction, stroke, limb ischemia, gangrene or amputation (HR, 2.90 (95% CI 1.19-7.04), p = 0.019). CONCLUSIONS: Pre-transplant screening for PAD and cardiovascular risk factors with non-invasive ABI testing may help to reduce perioperative complications in high-risk patients. Future research on long-term outcomes might provide more in depth insights in optimal treatment strategies for PAD among SPKT recipients.
Authors: J I Weitz; J Byrne; G P Clagett; M E Farkouh; J M Porter; D L Sackett; D E Strandness; L M Taylor Journal: Circulation Date: 1996-12-01 Impact factor: 29.690
Authors: Keattiyoat Wattanakit; Aaron R Folsom; Elizabeth Selvin; Josef Coresh; Alan T Hirsch; Beth D Weatherley Journal: J Am Soc Nephrol Date: 2007-01-10 Impact factor: 10.121
Authors: Joseph T Knapper; Zankhana Raval; Matthew E Harinstein; John J Friedewald; Anton I Skaro; Michael I Abecassis; Ziad A Ali; Mihai Gheorghiade; James D Flaherty Journal: J Cardiovasc Med (Hagerstown) Date: 2019-02 Impact factor: 2.160
Authors: Hans W Sollinger; Jon S Odorico; Yolanda T Becker; Anthony M D'Alessandro; John D Pirsch Journal: Ann Surg Date: 2009-10 Impact factor: 12.969
Authors: Matthew A Allison; William R Hiatt; Alan T Hirsch; Joseph R Coll; Michael H Criqui Journal: J Am Coll Cardiol Date: 2008-04-01 Impact factor: 24.094
Authors: Hans-Michael Hau; Nora Jahn; Maximilian Brunotte; Andri Arnosson Lederer; Elisabeth Sucher; Franz Maximilian Rasche; Daniel Seehofer; Robert Sucher Journal: BMC Endocr Disord Date: 2020-02-27 Impact factor: 2.763