Title: High Rate of Charcot Foot Attacks Early After Simultaneous Pancreas-Kidney Transplantation
Authors: Giovanni Marticali, Bert Bammens, Dirk Kuypers, Maria Flour, Chantal Mathieu (Belgium)
Source: Transplantation. 2007; 83 (2): 245-246
PODIATRIC RELEVANCE:
Although there is a high number of foot and ankle fractures reported after simultaneous pancreas-kidney transplant, there has been very little reported regarding the incidence of Charcot foot in these patients. The purpose of this study was to perform an analysis of the prevalence of Charcot foot in patients undergoing this type of transplant in order to possibly identify any predisposing factors.
METHODS:
A retrospective analysis of medical records were performed on all patients undergoing a simultaneous pancreatic-kidney transplant at the authors’ facility. The patients in question were all type I diabetics and had their surgery between 1992 and 2004. Data was collected regarding several factors, including diabetes and nephropathy dates of diagnosis, mean glycosylated hemoglobin, mean C-peptide (post-surgical), presence or absence of retinopathy, and any episodes of rejection.
Gazis’ criteria was used to diagnose Charcot foot, however, those with an isolated fracture of the metatarsals were also included. A univariate analysis was performed using the Cox regression to compare patients with and without Charcot foot. P values less than 0.05 were considered significant.
RESULTS:
No patients had Charcot foot prior to transplantation. Out of 66 patients, 8 developed Charcot foot, 4 of which developed it within one year of surgery. Additionally, 4 patients had bilateral involvement. The only statistical significant factor analyzed was glycosylated hemoglobin pretransplant. Those in the group with Charcot foot had poorer control of their diabetes pretransplant. Also, those patients that developed Charcot foot had a significantly higher mortality (3/8) and rejection rate (6/8) than those without (11/58 and 28/58 respectively).
COMMENTS:
This retrospective analysis identifies a higher prevalence of Charcot foot in this population as opposed to the general diabetic population. As stated by the authors, the reasons for this are multi-factorial. The majority of patients in this study’s population already have pre-disposing factors for Charcot foot. The contribution of immunosuppressive therapy is not clearly identified in this study, although they do discuss the controversy surrounding it. The authors also clearly identify the weaknesses in their study, including the retrospective nature of the design, the small sample size, the limited data studied (only medical records), and no matching non-transplantation patients as a control.
However, this study does identify a lesser-studied population in which the development of Charcot foot is not adequately studied. It also alerts the clinician to maintain a level of clinical suspicion for this condition in a population in which they otherwise may not have. Further research is needed to understand the causative factors behind and the true prevalence and incidence of this condition in this patient population.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.