72-OR: Clinical Burden and Impact of New-Onset Diabetic Foot Ulcers, Post-Simultaneous Pancreas Kidney Transplantation, and Kidney Only Transplantation

Background: Patients with diabetes and renal dysfunction are at risk of diabetic foot ulcers (DFU). Whether this risk is modified post simultaneous pancreas-kidney (SPK) or kidney only (KO) transplant is unknown.

Aims: We evaluated the incidence of new onset DFU post SPK and KO transplant performed between 2004 and 2014 in 234 patients with diabetic kidney disease.

Methods: In total 90 (51% male) SPK patients and 144 KO (66% male, 26% type 1 DM) were evaluated in a single centre retrospective study. Median (range) follow-up was 6 (3 to 13) years for both cohorts.

Results: We observed that 16 (17%) of SPK and 22 (15%) KO patients respectively developed a new DFU during follow-up. Nearly 60% of new onset DFU presented within 500 days post SPK transplant. In KO cohort more than 50% of DFU presented within 1000 days post kidney transplant. In both cohorts a history of peripheral vascular disease (PVD) [37.5% vs. 4%] and pre-transplant history of DFU were associated with post transplant DFU p<0.05. In KO cohort, patients who developed a DFU were more likely to have T1DM than T2DM (29% vs. 10%), and had higher pre-transplant HbA1c, (mean ± standard deviation [7.5 ±1.2% vs. 6.8±1.4%, p<0.05]). There was no impact of DFU on SPK transplant failure. In contrast patients with DFU post KO transplant had more than five fold increased hazard ratio (HR) of transplant failure as compared to those without DFU independent of other risk factors [HR 5.19 95% CI (2.05 to 13.18) p=0.001].

Conclusion: There is a residual high burden of new onset DFU post KO or SPK transplantation. Our results highlight the need for greater awareness of regular foot examination, DFU prevention and risk evaluation in post-transplant patients.