Kidney transplant increases the risk of ipsilateral critical limb ischemia

Objectives: End-stage renal disease is a known risk factor for peripheral arterial disease (PAD). Hypertension, hyperlipidemia, and diabetes, which are highly prevalent in renal transplant candidates, are independent risk factors for atherosclerosis and PAD. Renal transplantation is an invasive arterial procedure that may have effects on ipsilateral limb perfusion and/or progression of atherosclerotic disease. We hypothesized that the lower extremity ipsilateral to the side of the kidney transplant may be at increased risk for PAD complications. Methods: Our transplant database was retrospectively queried for all kidney transplant patients who underwent subsequent lower extremity revascularization or amputation procedures. Patients with concomitant pancreatic transplants or bilateral renal transplants were excluded. Patient demographics, comorbidities, and discharge medications were collected, and data analysis was conducted on SPSS 22.0 software (IBM Corp, Armonk, NY). Results: Between January 2004 and August 2016, 1214 patients received a renal transplant at our tertiary referral center. Of these, 25 patients (2%) had subsequent arterial revascularizations or amputations on either lower extremity. Average age was 55 years; 76% were male, 65% were African American, 92% had diabetes, 92% had hypertension, 44% had a history of coronary artery disease, and 72% were on aspirin or another antiplatelet agent. Eighteen patients had lower extremity vascular interventions (13 amputations and 5 revascularizations) ipsilateral to the transplanted kidney, and seven patients had contralateral vascular interventions (all amputations; P =.043). The average interval between transplantation and subsequent vascular intervention was 27 months for the ipsilateral interventions and 39 months for the contralateral interventions (P =.37). Conclusions: Kidney transplantation is associated with an increased risk of ipsilateral lower extremity PAD requiring surgical intervention. Further studies are necessary to determine whether this represents a “steal” phenomenon vs progression of atherosclerosis distal to the transplanted kidney. Renal transplant patients should be monitored closely for the development of ischemic symptoms in the lower extremity ipsilateral to the transplanted kidney