AbstractBackgroundThe benefits of kidney transplantation in diabetic patients with peripheral vascular disease (PVD) are unclear. While patients may have improved survival compared to dialysis, the burden of care after transplant has not been assessed.MethodsWe performed a retrospective review of adult diabetic kidney‐only transplant recipients with and without PVD transplanted from January 2012 until June 30, 2015.ResultsOf 203 diabetic kidney transplant recipients, 56 (27.6%) had PVD and 147 (72.4%) had no PVD. At a median of 3.14 years follow‐up, there were no significant differences in 30‐, 90‐, or 1‐year readmission rates. At 1 year after transplant, PVD patients were significantly more likely to have a greater sum of unplanned inpatient days (44.6% vs 27.9% with ≥10 inpatient days, P = .03) and at least 1 reoperation (28.6% vs. 8.7%, P < .01). At 1 year post‐transplant, there were similar rates of graft‐related reoperations; however, patients with PVD had significantly increased rates of non‐graft‐related operations of which 31.2% were PVD‐related.ConclusionsDiabetic patients with PVD utilize more resources after kidney transplant, spending more time in the hospital and undergoing more post‐transplant operations. The causes of readmission are predominantly related to progression of PVD rather than allograft complications.