[Risk factors for diabetic foot in recipients of renal and pancreatic transplants].

BACKGROUND

The risk of tissue damage of the foot in diabetic subjects is due to a combination of arterial insufficiency and peripheral neuropathy. The probable development of diabetic foot with possible subsequent amputation is greater in uraemic diabetics. The objective of the presented work was to assess the incidence and risk of diabetic foot in diabetic patients where on account of renal failure transplantation of the kidney was performed.

METHODS AND RESULTS

In a retrospective study in 1983-1992 for a period of 6 months to 7 years a group of 64 diabetics was investigated (37 men and 27 women), mean age 42.8 years, range 29-58 years where on account of diabetic nephropathy renal (n = 49, 76.6%) or renal and pancreatic transplantation (n = 15, 23.4%) was performed. At the time of transplantation 53 patients (82.8%) suffered from peripheral neuropathy, 24 (37.5%) from angiopathy of the lower extremities. During the follow up period 22 patients (34.4%) developed ulcerations of the skin of the lower extremities, incl. 15 patients (23.4%) with a local and 4 (6.3%) with a phlegmonous infection. In 10 patients (15.6%) amputation had to be performed.

CONCLUSIONS

Ulceration of the foot in diabetics cannot be prevented by transplantation of the kidney or transplantation of the kidney and pancreas. Ulceration of the foot is at present an important contraindication for transplantation.