Effect of Peripheral Vascular Disease on Kidney Allograft Outcomes: A Study of U.S. Renal Data System

Background The U.S. Renal Data System was used to analyze renal allograft outcomes in patients with peripheral vascular disease (PVD) at the time of transplant listing. Methods We used an incident cohort of patients who underwent renal transplantation between June 2004 and September 2009. We defined PVD as symptomatic PVD at wait-listing. Comorbid conditions were diabetes mellitus, ischemic heart disease, cerebrovascular disease, hypertension, and smoking. Chi-square test, Student’s t test, and Cox regression were used for statistical associations. Results The mean graft survival was 55.3±0.40 months in patients with PVD versus 60.8±0.06 months in patients without PVD. There was an increased risk of graft failure with PVD (hazard ratio, 2.01; 95% confidence interval, 1.83–2.21; P=0.0001). After adjusting for other variables, PVD remained an independent risk factor for graft failure. Patients with PVD had lower death-censored graft survival versus patients without PVD at 1 year (93.3% vs. 96.6%), 2 years (89.7% vs. 95%), and 3 years (87.2% vs. 93.7%). All-cause mortality was higher in PVD versus without PVD (6.2% vs. 3.0%). In African Americans, the mean allograft survival was 54.8±0.98, months with PVD versus 59.7±0.135 months without PVD (P=0.0001). In non–African Americans, the mean allograft survival was 55.4±0.44 months with PVD versus 61.1±0.069 months without PVD (P=0.0001). There were no differences in survival between African Americans with PVD and non–African Americans with PVD. Conclusions Patients with PVD have inferior allograft and patient survival versus those without PVD. Caution should be exercised when placing patients with symptomatic PVD or amputation on the wait-list.

[1]  E. Mohler,et al.  Peripheral arterial disease, prevalence and cumulative risk factor profile analysis , 2014, European journal of preventive cardiology.

[2]  L. Wong,et al.  Should peripheral vascular disease- or diabetes-related amputation contraindicate renal transplant? , 2012, Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health.

[3]  L. Weissfeld,et al.  Peripheral vascular disease severity impacts health outcomes and health-related quality of life in maintenance hemodialysis patients in the HEMO Study. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[4]  J. Birkmeyer,et al.  Racial disparities in the use of revascularization before leg amputation in Medicare patients. , 2011, Journal of vascular surgery.

[5]  A. Webster,et al.  Cardiac testing for coronary artery disease in potential kidney transplant recipients: a systematic review of test accuracy studies. , 2011, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[6]  S. Muluk,et al.  The effect of immunosuppression on lower extremity arterial bypass outcomes. , 2011, Annals of vascular surgery.

[7]  D. Etzioni,et al.  Racial and ethnic differences in patterns of treatment for acute peripheral arterial disease in the United States, 1998-2006. , 2010, Journal of vascular surgery.

[8]  Y. Ostchega,et al.  Prevalence of Peripheral Arterial Disease and Risk Factors in Persons Aged 60 and Older: Data from the National Health and Nutrition Examination Survey 1999–2004 , 2007, Journal of the American Geriatrics Society.

[9]  S. Rajagopalan,et al.  Peripheral Arterial Disease in Patients With End-Stage Renal Disease: Observations From the Dialysis Outcomes and Practice Patterns Study (DOPPS) , 2006, Circulation.

[10]  B. Kasiske,et al.  Peripheral arterial disease and renal transplantation. , 2006, Journal of the American Society of Nephrology : JASN.

[11]  A. Zaslavsky,et al.  Trends in the quality of care and racial disparities in Medicare managed care. , 2005, The New England journal of medicine.

[12]  Elizabeth Selvin,et al.  Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States: Results From the National Health and Nutrition Examination Survey, 1999–2000 , 2004, Circulation.

[13]  D. Goldfarb.  Death in the first year after kidney transplantation: implications for patients on the transplant waiting list. , 2003, The Journal of urology.

[14]  B. Pereira,et al.  Death in the first year after kidney transplantation: implications for patients on the transplant waiting list12 , 2003, Transplantation.

[15]  K. Johansen,et al.  Lower-extremity peripheral arterial disease among patients with end-stage renal disease. , 2001, Journal of the American Society of Nephrology : JASN.

[16]  D. Mukamel,et al.  Racial differences in access to high-quality cardiac surgeons. , 2000, American journal of public health.

[17]  R. Merion,et al.  PERIPHERAL VASCULAR OCCLUSIVE DISEASE IN RENAL TRANSPLANT RECIPIENTS: RISK FACTORS AND IMPACT ON KIDNEY ALLOGRAFT SURVIVAL , 2000, Transplantation.

[18]  B. Kasiske,et al.  Cardiovascular disease after renal transplantation. , 2000, Journal of the American Society of Nephrology : JASN.

[19]  R. Califf,et al.  Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? , 1997, The New England journal of medicine.

[20]  E. Braunwald,et al.  Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction: The TIMI III registry. , 1996 .

[21]  C. Gatsonis,et al.  Racial differences in the use of revascularization procedures after coronary angiography. , 1993, JAMA.

[22]  R. Langer,et al.  Mortality over a period of 10 years in patients with peripheral arterial disease. , 1992, The New England journal of medicine.

[23]  How good are the data? USRDS data validation special study. , 1992, American journal of kidney diseases : the official journal of the National Kidney Foundation.