Does kidney transplantation to iliac artery deteriorate ischemia in the ipsilateral lower extremity with peripheral arterial disease?

Northcutt, Ashley; Zibari, Gazi B.; Tan, Tze‐Woei; Coulter, Amy; Zhang, Wayne W.

doi:10.1177/1708538114555154

Cited by 11 publications

(11 citation statements)

References 9 publications

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“…In our population, screening with ABIs was performed routinely on all patients with no reports of lower extremity ischemic symptoms after 1 year of follow‐up. This result is similar to the findings in Northcutt's retrospective review of ischemic symptoms in the ipsilateral limb of renal transplant patients with peripheral arterial disease; however, none of the patients required endarterectomy . Sagban et al reported on their experience with an extensive preoperative screening approach with duplex studies, and angiograms when indicated .…”

Section: Discussionsupporting

confidence: 82%

Simultaneous recipient external iliac endarterectomy and renal transplant – a propensity score matched analysis

et al. 2019

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Summary Patients with end‐stage renal disease and severe iliac atherosclerosis are frequently denied renal transplant due to technical challenges, and risk of potential steal syndrome in the allograft, or ipsilateral limb. Few studies have evaluated the safety and efficacy of performing an endarterectomy in this setting. A single‐center retrospective review of renal transplant patients from 1/2013 to 12/2017 was performed. Patients requiring endarterectomy at the time of transplant were matched to a nonendarterectomized cohort in a 1:2 fashion using propensity score matching. Patients were followed for a minimum of 12 months. Simultaneous endarterectomy and renal transplant were performed in 23 patients and subsequently matched to 42 controls. Ankle‐brachial index was lower in the endarterectomized group (P = 0.04). Delayed graft function (26.1% vs. 19%, P = 0.54), graft loss (8.7% vs. 7.1%, P = 0.53), 1‐year mortality (8.7% vs. 4.8%, P = 0.53), and renal function at 12 months were comparable in both groups. There were no incidents of ipsilateral limb loss in the endarterectomized population. This is the first matched study investigating endarterectomy and renal transplant. Long‐term follow‐up of limb and graft function is indicated. Despite the small sample size, our findings suggest that a combined procedure can safely provide renal transplantation access to a previously underserved population.

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Section: Discussionsupporting

confidence: 82%

Simultaneous recipient external iliac endarterectomy and renal transplant – a propensity score matched analysis

et al. 2019

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“…Another potential hypothesis is a steal phenomenon caused by anastomosing the donor kidney and pancreas to the recipient's left and right common iliac arteries, respectively, as described by Sollinger et al . Northcutt et al . investigated the steal phenomenon in KTA recipients with ipsilateral lower limb PAD and concluded that KTA did not significantly deteriorate lower limb ischemia.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous pancreas and kidney transplantation: Incidence and risk factors for amputation after 10‐year follow‐up

MacCraith

Davis

Browne

et al. 2017

Clinical Transplantation

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“…In case of compromised blood flow in the external iliac artery (EIA) caused by VC, a percutaneous transluminal angioplasty (PTA), endarterectomy or vascular bypass can be performed in a staged or simultaneous procedure . Second, vascular complications like steal syndrome or trash foot may be a threat to the vascular challenging transplant candidate . As a third reason, patients with VC are considered to have a limited life expectancy due to cardiovascular comorbidities, leading to a high perioperative mortality risk and limiting 5‐year patient survival to 35% .…”

Section: Introductionmentioning

confidence: 99%

The prognosis of kidney transplant recipients with aorto‐iliac calcification: a systematic review and meta‐analysis

et al. 2020

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The prognosis of kidney transplant recipients (KTR) with vascular calcification (VC) in the aorto-iliac arteries is unclear. We performed a systematic review and meta-analysis to investigate their survival outcomes. Studies from January 1st, 2000 until March 5th, 2019 were included. Outcomes for meta-analysis were patient survival, (death-censored) graft survival and delayed graft function (DGF). Twenty-one studies were identified, eight provided data for meta-analysis. KTR with VC had a significantly increased mortality risk [1-year: risk ratio (RR) 2.19 (1.39-3.44), 5-year: RR 2.28 (1.86-2.79)]. The risk of 1-year graft loss was three times higher in recipients with VC [RR 3.15 (1.30-7.64)]. The risk of graft loss censored for death [1-year: RR 2.26 (0.58-2.73), 3-year: RR 2.19 (0.49-9.82)] and the risk of DGF (RR 1.24, 95% CI 0.98-1.58) were not statistically different. The quality of the evidence was rated as very low. To conclude, the presence of VC was associated with an increased mortality risk and risk of graft loss. In this small sample size, no statistical significant association between VC and DGF or risk of death-censored graft loss could be demonstrated. For interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.

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Does kidney transplantation to iliac artery deteriorate ischemia in the ipsilateral lower extremity with peripheral arterial disease?

Abstract: Transplanted kidney to iliac artery does not significantly deteriorate ischemia in adults with ipsilateral lower extremity peripheral arterial disease. Late developed ischemic complications may be due to the progression of underlying arterial disease.

Cited by 11 publications

References 9 publications

Simultaneous recipient external iliac endarterectomy and renal transplant – a propensity score matched analysis

Simultaneous recipient external iliac endarterectomy and renal transplant – a propensity score matched analysis

Simultaneous pancreas and kidney transplantation: Incidence and risk factors for amputation after 10‐year follow‐up

The prognosis of kidney transplant recipients with aorto‐iliac calcification: a systematic review and meta‐analysis

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