Internal Medicine Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
The Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Diabetes Metab Res Rev. 2022 Nov;38(8):e3575. doi: 10.1002/dmrr.3575. Epub 2022 Sep 6.
Data regarding diabetic foot ulcers in patients after solid organ transplantation, particularly kidney transplantation, are limited. Chronic immunosuppression may be associated with impaired wound healing and a higher risk of amputations. In this study, we characterised the clinical presentation and outcomes of patients after kidney transplantation admitted to the diabetic foot unit, compared to non-kidney-transplant patients.
Data on the baseline characteristics, clinical presentation, and outcomes of all patients admitted to the diabetic foot unit of a large tertiary centre between the years 2014 and 2019 were collected. The most recent admission of each patient was considered. Primary outcomes were major amputations and 1 year mortality rate.
During the study period, 537 patients were hospitalised, 18 of them were receiving immunosuppressive therapy due to kidney transplantation. Baseline characteristics of the patients were broadly similar, except that smoking was reported by 22.0% of the non-transplant patients and by none of the post-transplant patients (p = 0.01). Post-transplant patients tended to be younger (59.4 ± 11.1 vs. 65.3 ± 12.2; p = 0.07), were more likely to have type-1 diabetes (16.7% vs. 5.2%; p = 0.07) and had lower glucose levels upon admission (9.4 ± 4.3 vs. 12.0 ± 6.4 mmol/L; p = 0.07). Overall, 30% of the patients underwent major amputation, in-patient mortality rate was 9.3%, and 1 year mortality rate was 27.2%. Rates were similar in the post-transplant versus the non-post-transplant patients (p = 0.83, 1.00, 0.59, respectively).
Post-transplant patients did not incur worse outcomes in spite of immunosuppressive therapy. Limb salvage efforts should be pursued in these patients similar to the overall population.
有关实体器官移植（尤其是肾移植）后糖尿病足溃疡患者的数据有限。慢性免疫抑制可能与伤口愈合受损和截肢风险增加有关。在这项研究中，我们比较了肾移植后入住糖尿病足科的患者与非肾移植患者的临床特征和结局。
收集了 2014 年至 2019 年间在一家大型三级中心的糖尿病足科住院的所有患者的基线特征、临床表现和结局数据。每位患者最近一次入院时的数据被考虑在内。主要结局是大截肢和 1 年死亡率。
在研究期间，共有 537 名患者住院，其中 18 名患者因肾移植而接受免疫抑制治疗。患者的基线特征大致相似，但非移植患者中有 22.0%报告吸烟，而移植后患者中无一例报告（p=0.01）。移植后患者的年龄较小（59.4±11.1 岁比 65.3±12.2 岁；p=0.07），更可能患有 1 型糖尿病（16.7%比 5.2%；p=0.07），入院时血糖水平较低（9.4±4.3mmol/L 比 12.0±6.4mmol/L；p=0.07）。总的来说，30%的患者进行了大截肢，住院死亡率为 9.3%，1 年死亡率为 27.2%。移植后和非移植后患者的这些比率相似（p=0.83、1.00、0.59）。
尽管进行了免疫抑制治疗，移植后患者的结局并未恶化。在这些患者中，应像在总体人群中一样，努力保留肢体。
