Risk for kidney transplant failure quintuples with postsurgical diabetic foot ulcer
Kidney transplantation is more likely to fail for adults with diabetic kidney disease and diabetic neuropathy who then present with a diabetic foot ulcer after surgery vs. those without foot ulcer, according to findings presented at the American Diabetes Association 79th Scientific Sessions. In addition, common factors for post-transplant diabetic foot ulcers include a prior history of the condition as well as previous peripheral arterial disease.
“If you get a foot ulcer, if you have a kidney-only transplant, it affects the viability in terms of you have a greater risk of transplant failure.,” Janaka Karalliedde, PhD, MBBS, FRCP, FHEA, consultant in diabetes and endocrinology in the department of diabetes and endocrinology at Guy’s and St Thomas’ NHS Foundation Trust in London, told Endocrine Today. “It could be bidirectional, but what it clearly shows is that having a foot ulcer is bad and that it has some impact on your transplant.”
Based on medical records from 2004 to 2014, Karalliedde and colleagues assessed the outcomes of simultaneous pancreas-kidney transplantation (n = 90; median age, 49 years; 49% women) or kidney-only transplantation (n = 145; median age, 62 years; 34% women) in adults with type 1 or type 2 diabetes. Every participant also had diabetic kidney disease and diabetic neuropathy before surgery.
The researchers reported postoperative diabetic foot ulcer in 17% of those who underwent simultaneous pancreas-kidney transplantation and 15% who had who had kidney-only transplantation. Diabetic foot ulcers occurred among a higher percentage of those with peripheral artery disease (PAD) who had a simultaneous pancreas-kidney transplant compared with those without PAD (37.5% vs. 4%; P < .05). Similarly, more participants with PAD had a diabetic foot ulcer after surgery for kidney-only transplantation compared with those without PAD (32% vs. 8%; P < .05). The researchers added that more participants with type 1 diabetes who had a kidney-only transplant were diagnosed with diabetic foot ulcer after surgery vs. those with type 2 diabetes (29% vs. 10%; P < .05). In addition, compared with those without a diabetic foot ulcer, a kidney-only transplantation was five times more likely to fail if a participant had a foot ulcer (HR = 5.19; 95% CI, 2.05-13.18).
“For all the health care professionals who look after these patients post-transplant, they should really be focusing on foot surveillance so that you can pick up an early warning promptly and treat,” Karalliedde said. “It’s also for the transplant community because it’s something that they need to be aware [of]. ... The majority of diabetic foot ulcers can be prevented with education and patient self-management so it’s to continue to reinforce that.” – by Phil Neuffer
Karalliedde J, et al. Clinical burden and impact of new-onset diabetic foot ulcers, post-simultaneous pancreas-kidney transplantation and kidney-only transplantation. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, San Francisco.
Disclosure: Karalliedde reports no relevant financial disclosures.