**3.3 Renal transplantation in diabetic patients**

There is limited data to the contribution of kidney transplantation on the onset and progression of DFU. However, it is well-known that as a result of induction and maintenance of immunosuppression in kidney transplant recipients, they represent a special group that is highly susceptible to infection. Diabetic patients in this group may develop DFU from opportunistic infections which require hospital admissions because these infections are difficult to treat. Moreover, their compromised immune system due to immunosuppressive therapy may impair wound healing. Such a condition may lead to septicemia which can progress to sepsis [126]. There are studies showing amputation rates as high as 30% in this group of patients [126–128]. It is important to note that peripheral vascular disease is common among renal transplant recipients [127, 129], which increases their risk for DFU development. In the light of this, Sharma et al. [130] recently reported that about 1 in 7 patients develop a new onset DFU following kidney transplantation or simultaneous pancreas-kidney transplantation although glycemic status is well-controlled. They also observed that DFU increases the risk of failure of the renal graft [130]. Although data regarding the effect of kidney transplantation on DFU development and progression are scarce, the few studies done so far suggest that kidney transplantation increases the risk of developing DFU.
