Peripheral vascular occlusive disease in renal transplant recipients: Riskfactors and impact on kidney allograft survival

Background. This study evaluated the relationship between renal transplanta tion and the evolution of lower extremity peripheral vascular occlusive dis ease (PVOD). Methods. A total of 664 adult renal allograft recipients from 1985-1995 wer e retrospectively reviewed for atherosclerotic risk factors and peripheral vascular occlusive disease (PVOD). PVOD events were defined as by-pass, maj or amputation, claudication, or percutaneous angioplasty. Follow-up ranged from 2-12 years. Results. The cumulative 5- and 10-year incidences of lower extremity PVOD a fter renal transplantation were 4.2 and 5.9%. Eight of 14 patients (57%) wi th pretransplant PVOD had additional PVOD events versus de novo appearance of PVOD in 21/650 patients (3.2%; P<0.0001). In a proportional hazards mode l, age, preoperative PVOD, diabetes, and postoperative smoking were indepen dent risk factors for the development of PVOD after transplantation. Recipi ents with lower extremity PVOD had significantly lower 10-year patient and graft survival. Increased graft failure was due to an excess of deaths with a functioning graft. A total of 34 major interventions were performed. One - and two-year limb salvage rates were 64.2 and 53.8%. Conclusions. Lower extremity PVOD after renal transplantation is associated with diminished patient survival, and affects kidney graft survival via di sproportionate patient attrition. Age, preoperative PVOD, diabetes, and pos toperative smoking are important risk factors. Transplantation does not app ear to either accelerate or retard the progression of disease. An aggressiv e approach towards limb salvage in properly selected patients is justifiabl e.