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Abstract: TH-PO150

New Onset Diabetic Foot Ulcer After Renal Transplantation Increases Risk of Transplant Failure

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Sharma, Angelica, King's College London, UK, London, United Kingdom
  • Cohen, Siew, Guy''s and St Thomas'' NHS Trust, London, United Kingdom
  • Gnudi, Luigi, King's College London, UK, London, United Kingdom
  • Vas, Prashanth R j, King''s College Hospital, London, United Kingdom
  • Karalliedde, Janaka J., King's College London, UK, London, United Kingdom
Background

Patients with diabetic kidney disease are at high risk of diabetic foot ulcers (DFU). Whether this risk is modified after renal transplant is unclear. There is a paucity of information on the burden and risk factors for DFU development after transplantation and impact of DFU on renal transplant viabilty.

Methods

We evaluated the incidence and predictors of new onset DFU post renal transplant in a single centre retrospective study. Patients who underwent renal transplant for diabetic kidney disease between 2004-2016 were evaluated.
In total 144 (66% male, 26% Type 1, 74% Type 2 ) diabetic patients were evaluated. Median (range) follow up was 6 (3 to 13) years. Median (range) age was 62 (28 to 80) years and duration of diabetes 23 (7-60) years. Electronic patient medical notes were reviewed.

Results

Over the follow up period 22 (15%) patients developed a new DFU. Patients with a DFU were of similar age, body mass index, diabetes duration and had similar pre-transplant haemoglobin, as compared to those without a DFU. Patents who developed a DFU were more likely to have Type 1 than Type 2 diabetes (29% vs. 10%), history of peripheral vascular disease (PVD) [32 % vs. 8%], had higher pre-transplant HbA1c, mean ± standard deviation (7.5 ±1.2% vs. 6.8±1.4%) and serum creatinine (809±243µmol/l vs. 660±202µmol/l) p<0.05 for all.
Of the cohort 8 patients had a history of DFU pre-transplant and all 8 developed a new onset DFU post-transplant. Median (range) duration of healing was 5 (1-26) weeks. Nearly 50% of all DFU occurred within the first 1000 days post-transplant. Of the 22 cases, 6 needed a minor amputation; no major amputations were documented. Mortality was 27.3% in patients with DFU compared to 20.3% without DFU p=0.25.
Patients with DFU had more than twofold increased risk of transplant failure as compared to those without DFU (50% vs 23.3% p=0.02).

Conclusion

Nearly 1 in 7 patients post renal transplant develop a new onset DFU. Type 1 diabetes, higher pre-transplant HbA1c, serum creatinine and history of PVD and prior DFU are associated with increased risk of new onset DFU post-transplant. DFU increases risk of transplant failure nearly twofold.
Our results indicate a high burden of DFU post-transplant and emphasises the requirement for regular foot surveillance by renal and diabetes clinical teams in this high-risk population.

Funding

  • Government Support - Non-U.S.