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https://doi.org/10.1097/01.tp.0000886000.95956.57
Copy DOIJournal: Transplantation | Publication Date: Sep 1, 2022 |
Methods: In a single center retrospective chart-review study, we reviewed the outcomes renal transplant recipients who underwent renal transplant from January 2017 to May 2020. We divided the group based on their dialysis vintage, less than 3 years versus more than 3 years. We collected the data about the patients’ demographics, cardiovascular risk factor, dialysis modality, pre-transplant work-up images, and the changes in cardiovascular risk factors in the first post-transplantation year. Results: We included 278 patients, 109 patients in the longer vintage group and 169 patients in the shorter vintage group. The mean age 43.8±16.1 and 164 patients (59%) were male. The mean dialysis vintage in the shorter group was 1± 0.1 year, and 5.7± 2.7 years in the longer vintage group, p <0.001. The most common comorbidities were hypertension (76%), followed by diabetes mellitus (41.7%), and were present in similar proportions of both groups. Compared to the shorter dialysis vintage group, those who had longer dialysis vintage were more likely to have a deceased kidney donor (36.7% vs 8.9%, p <0.001), receive hemodialysis (88.1% vs 76%; p=0.006), predominantly through an arteriovenous fistula (55% vs 20.7%; p <0.001). The results of pretransplant work up including cardiac stress test, calcium scoring, coronary angiogram, cardiac ejection fraction, left ventricular hypertrophy, wall motion abnormalities and the degree of calcifications of pelvic arteries on pelvic Ct scan did not differ between the two groups. In the first post-transplantation year, patients in the longer vintage group were more likely to have reduction in their systolic blood pressure (-7.1±20.7 mmHg vs -1.6±17.5; p=0.027) and were at a higher risk of developing persistent hyperparathyroidism, defined as parathyroid hormone (iPTH) greater than 25.5 pmol/l at one year post transplantation, (27% vs 18%, p=0.003). However, patients in the shorter vintage group were more likely to have post-transplant weight gain (6.8±8.8 kg vs 4.7±; p=0.039). Post transplantation diabetes (PTDM) and morbid obesity at one-year post-transplantation were similar between the two groups. Conclusions: Our study showed that patients with dialysis vintage up to 3 years were not different in their baseline traditional risk factors, cardiovascular pre-transplant work up, nor the changes post renal transplant. This suggest that the increase of mortality related to dialysis vintage might be related to other factors such as uremia, electrolytes shifts and/ or infections. Further studies with longer follow up are needed to investigate if dialysis vintage longer than three years would affect the pre-transplant cardiovascular risk factors or the findings of pre-transplant cardiovascular imagings.
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