Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany.
Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
BMC Surg. 2021 Mar 22;21(1):156. doi: 10.1186/s12893-021-01159-6.
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.
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.
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).
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.
患有 1 型胰岛素依赖型糖尿病（IDDM1）和终末期肾病（ESKD）的患者同时进行胰腺肾移植（SPKT），这些患者存在弥漫性动脉粥样硬化，并且存在较高的心脑血管发病率和死亡率风险。我们旨在研究术前筛查外周动脉疾病（PAD），特别是踝肱指数（ABI）测试的可行性，以预测 SPKT 受者的围手术期结局。
回顾性分析了我们移植中心所有接受 SPKT 的 IDDM 和 ESKD 患者的医疗数据（2000-2016 年）。研究了 PAD（SPKT 前 ABI 异常和移植物失功和死亡率作为主要终点定义）与主要终点（死亡和胰腺移植物失功）以及急性心肌梗死、脑血管和外周血管并发症作为次要终点之间的相关性，在调整已知心血管危险因素后进行。
在我们移植人群中接受结构性生理动脉研究的 101 例 SPKT 受者中，17 例（17%）在移植前被诊断为 PAD。ABI 指数降低定义的 PAD 是死亡的独立且显著预测因素（HR，2.99（95%CI 1.00-8.87），p=0.049）和胰腺移植物失功（HR，4.3（95%CI 1.24-14.91），p=0.022）。未观察到肾移植物失功的差异（HR 1.85（95%CI 0.76-4.50），p=0.178）。就次要结局而言，PAD 患者更有可能发生心肌梗死、中风、肢体缺血、坏疽或截肢（HR，2.90（95%CI 1.19-7.04），p=0.019）。
术前筛查 PAD 和心血管危险因素，并使用无创 ABI 检测，可能有助于降低高危患者的围手术期并发症。关于长期结局的未来研究可能会为 SPKT 受者的 PAD 最佳治疗策略提供更深入的见解。
