Effect of Peripheral Vascular Disease on Kidney Allograft Outcomes: A Study of US 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, 1.83Y2.21; 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 nonYAfrican 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.