Foot & Ankle International - June 2017 - 656

696246

FAIXXX10.1177/1071100717696246Foot & Ankle InternationalSeo et al

research-article2017

Article

Diabetic Foot Complications Despite
Successful Pancreas Transplantation

Foot & Ankle International®
2017, Vol. 38(6) 656-661
© The Author(s) 2017
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https://doi.org/10.1177/1071100717696246
DOI: 10.1177/1071100717696246
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Dong-Kyo Seo, MD1, Ho Seong Lee, MD, PhD2, Jungu Park, MD2,
Chang Hyun Ryu, MD2, Duck Jong Han, MD, PhD3, and Sang Gyo Seo, MD2

Abstract
Background: It is known that successful pancreas transplantation enables patients with diabetes to maintain a normal
glucose level without insulin and reduces diabetes-related complications. However, we have little information about the
foot-specific morbidity in patients who have undergone successful pancreas transplantation. The purpose of this study was
to investigate the prevalence and predisposing factors for foot complications after successful pancreas transplantation.
Methods: This retrospective study included 218 patients (91 males, 127 females) who had undergone pancreas
transplantation for diabetes. The mean age was 40.7 (range, 15-76) years. Diabetes type, transplantation type, body mass
index, and diabetes duration before transplantation were confirmed. After pancreas transplantation, the occurrence and
duration of foot and ankle complications were assessed.
Results: Twenty-two patients (10.1%) had diabetic foot complications. Fifteen patients (6.9%) had diabetic foot ulcer and
7 patients (3.2%) had Charcot arthropathy. Three patients had both diabetic foot ulcer and Charcot arthropathy. Three
insufficiency fractures (1.4%) were included. Mean time of complications after transplantation was 18.5 (range, 2-77)
months. Creatinine level 1 year after surgery was higher in the complication group rather than the noncomplication group
(P = .02).
Conclusion: Complications of the foot and ankle still occurred following pancreas transplantation in patients with diabetes.
Level of Evidence: Level III, comparative study
Keywords: pancreas transplantation, diabetes, diabetic foot, diabetic ulcer, Charcot arthropathy

Introduction
Diabetic foot disease is one of the most common complications of diabetes mellitus (DM). The incidence of diabetic
foot ulcers in diabetic patients ranges from 15% to 25%.1,2,13
Diabetic foot ulcers cause infection and can lead to lowerlimb amputation. Previous studies have reported that the
mortality rate after diabetic foot amputation ranges from
13% to 40% within 1 year, from 35% to 65% at 3 years, and
from 39% to 80% at 5 years, which is worse than the rate for
most malignancies.8,12,14,15
Pancreas transplantation has been recognized as an
effective method for controlling blood glucose in type 1
diabetes without insulin and reducing or delaying diabetesrelated complications.4,9,10 However, the procedure comes
with its own complications, such as pancreatic graft failure
because of rejection and other organ complications. Del
Vecchio et al reported 2 cases of Charcot neuroarthropathy
that developed after simultaneous kidney/pancreas transplantation (SKPT).6 Other studies have reported rates of
prevalence of Charcot neuroarthropathy after SKPT from
9.0% in 100 patients to 12% in 66 patients.7,11

However, to our knowledge, there have been no comprehensive studies regarding foot and ankle complications
including Charcot arthropathy after pancreas transplantation. The only studies we found of Charcot arthropathy after
pancreas transplantations were case reports or studies that
involved a small volume of cases.3,6 In our hospital, many
pancreas transplantations are being performed and followed. The purpose of this study was to investigate the
prevalence and predisposing factors for foot and ankle complications after successful pancreas transplantations in diabetic patients.
1

Department of Orthopedic Surgery, Gangneung Asan Hospital, College
of Medicine, University of Ulsan, Seoul, Republic of Korea
2
Department of Orthopedic Surgery, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, Republic of Korea
3
Department of Surgery, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, Republic of Korea
Corresponding Author:
Sang Gyo Seo, MD, Department of Orthopedic Surgery, Asan Medical
Center, Olympic-ro 43 gil 88, Songpa-gu, Seoul, Republic of Korea.
Email: sgseo@amc.seoul.kr
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