Peripheral arterial disease preoperatively may predict graft failure and mortality in kidney transplant recipients

Salma I. Patel, Harini A. Chakkera, Paul W. Wennberg, David A. Liedl, Fadi Alrabadi, Stephen S. Cha, Darren D. Hooley, Hatem Amer, Hani M. Wadei, Fadi E. Shamoun

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Patients with end-stage renal disease undergoing kidney transplant often have diffuse atherosclerosis and high cardiovascular morbidity and mortality rates. We analyzed the correlation of peripheral arterial disease (PAD), here quantified by an abnormal ankle-brachial index (ABI) measured within the 5 years prior to kidney transplant, with graft failure and mortality rates (primary end points) after adjusting for known cardiovascular risk factors (age, sex, smoking history, hypertension, diabetes, stroke, known coronary artery disease or heart failure, years of dialysis). Of 1055 patients in our transplant population, 819 had arterial studies within the 5 years prior to transplant. Secondary end points included myocardial infarction; cerebrovascular accident; and limb ischemia, gangrene, or amputation. Low ABI was an independent and significant predictor of organ failure (OR, 2.77 (95% CI, 1.68-4.58), p<0.001), secondary end points (HR, 1.39 (95% CI, 0.97-1.99), p<0.076), and death (HR, 1.84 (95% CI, 1.26-2.68), p=0.002). PAD was common in this population: of 819 kidney transplant recipients, 46% had PAD. Low ABI was associated with a threefold greater risk of graft failure, a twofold greater risk of death after transplant, and a threefold greater risk of secondary end points. Screening for PAD is important in this patient population because of the potential impact on long-term outcomes.

Original languageEnglish (US)
Pages (from-to)225-230
Number of pages6
JournalVascular Medicine (United Kingdom)
Issue number3
StatePublished - Jun 2017
Externally publishedYes


  • ankle-brachial index (ABI)
  • kidney
  • morbidity
  • mortality
  • peripheral arterial disease (PAD)
  • transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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