HIGH RATE OF CHARCOT FOOT ATTACKS EARLY AFTER SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION

Abstract

Background: Simultaneous pancreas-kidney transplantation is performed in type 1 diabetic patients with long standing diabetes and end stage renal disease. Morbidity and mortality rates early after transplantation are high, with lower limb amputations being an important event. However, no data are available on the exact rate of Charcot foot presentation after simultaneous pancreas-kidney transplantation. The aim of the present study was to examine the prevalence of Charcot foot in the population of simultaneous pancreas-kidney transplanted patients at our institution

Methods: We retrospectively examined the medical files and radiographic documents of 66 consecutive patients transplanted in our institution. Demographic and historical data collected included gender, date of diagnosis of DM and nephropathy, mean HbA1c and mean C-peptide, retinopathy and data on renal replacement therapy. Data on immunosuppressive therapy and transplant outcome were also collected.

Results: None of the patients was found to have Charcot foot before transplantation. 8 patients (12%) developed a Charcot foot afterwards (mean 1.8 ± 1.9 years post-transplantation) and four of them developed bilateral involvement in time (6%). No new Charcot foot attacks in the previously affected foot were recorded. Considering the pre-transplant demographic characteristics, all 66 patients were at high risk to develop Charcot foot. Comparing patients who developed Charcot foot to those who did not, a significant difference was only found for pre-transplant glycemic control (mean HbA1c 9.2 ± 1.0 vs. 8.0 ± 1.4, p = 0.01). In patients developing Charcot foot, acute rejection, graft failure and mortality show a trend to be more frequent (HR = 3.57, p = 0.164, HR = 4.56, p = 0.165 and HR = 2.46, p = 0.236, respectively).

Conclusions: Charcot foot proves to be a frequent complication early after simultaneous pancreas-kidney transplantation. Considering the important morbidity and mortality of this complication, awareness of all healthcare providers treating transplanted patients is mandatory to detect a presentation early after onset. Prompt referral to a multidisciplinary diabetic foot clinic for further diagnosis and specialised treatment must always be considered.