1. Charcot neuroarthropathy after Simultaneous Pancreas Kidney transplantation: risk factors and evolution of prevalence over 20 years. Prof. Dr. GA Matricali Fernando García Barrado Prof. Dr. D Kuypers

2. Objective Evaluate risk factors for developing Charcot foot (CF) in a SPK-population Evolution in prevalence of CF Comparison of 2 cohorts (1992 – 1999; 1999 – 2012)

3. Introduction CF is present in 0.1 to 0.4% 1 of the general diabetes population Etiology of CF o French theory (Charcot) o Neurovascular theory o Neurotraumatic theory SPK: golden standard therapy for diabetes mellitus 1 (DM1) and end stage kidney failure (ESKF). 1 Coughlin M.J., Mann R.A., Saltzman C. Charcot neuroarthropathy of the foot in the diabetic patient: Do not delay the diagnosis and management. Surgery of the Foot and Ankle. 2007;2: 101 Jean-Martin Charcot

4. Materials and methods (1) Retrospective study Diabetes Mellitus type 1 and ESKF SPK in UZ Leuven Transplanted between 1992 en 2012 (n = 100) Medical files: electronic and paper Clinical and radiographic diagnosis

5. Materials and methods (2) Sex BMI Age at transplantation Retinopathy Duration and type of RRT Duration of DM Number of acute rejections Transplant outcome Drainagesite Donorkidney and implantation site Serum value: o Hba1c o Creatinine o Calcium o Phosphate Maintenance therapy: o CS o CsA o Tac o MMF o Aza

6. Results 9/100 (9%) developed CF, of which 4 in the first year post-transplant Higher mortality in CF patients (56 vs. 18% [p= 0.019]) Higher HbA1c serum values pre-transplant (p= 0.021) More acute rejections in CF group (78 vs 41% [p= 0.041]) Worse graft survival in CF group (33 vs 78% [p= 0.009]) Higher serum phosphate 1 year post-transplant in CF group (p= 0.04) 7/39 (18%) patients in the first cohort developed CF, only 2/61 (3%) in the second cohort (p= 0.026) Bladder drainage in cohort 1 (95%), in cohort 2 (10%) [p< 0.0001]

7. Immuunsuppressiva CF vs Non CF CF Non CF P = 0.060 P = 0.012 P = 0.007 P = 0.017 P = 0.047 Azathioprine Cyclosporine A Mycophenolaat mofetil Tacrolimus P = 0.028 P = 0.163 P = 0.081 P = 0.034 P = 0.003 Methylprednisolone (g)

8. Immuunsuppressiva cohorts <1999 ≥1999 P< 0.0001 Azathioprine Cyclosporine A Mycophenolaat mofetil Tacrolimus P< 0.0001 Methylprednisolone (g)

9. Discussion Diabetes and CF: o Etiology o HbA1c Corticosteroids o Suppression of bone formation o Less formation of type 1 collagen o Excessive bone resorption Maintenance immunosuppressive therapy

10. Conclusion Further research is necessary Importance of good glycemic control Avoidence of CS in maintenance therapy Importance of early detection The author declares that the research for and communication of this independent body of work does not constitute any financial or other conflict of interest.

11. Thank you for your attention