#515 The clinical utility of systematic screening using aortoiliac CT angiography before kidney transplantation

Abstract

Abstract Background and Aims Several guidelines suggest screening for peripheral artery disease before kidney transplantation including the Kidney Disease: Improving Global Outcomes. There is currently no consensus on whom or how to screen for peripheral artery disease. We examined the clinical consequences of systematic screening using aortoiliac computed tomography (CT) angiography in a large cohort of potential kidney transplant candidates. Method In a retrospective study, potential kidney transplant candidates underwent aortoiliac CT angiography as pretransplant screening for peripheral artery disease. Screening criteria were patients above 40 years, and/or diabetes, and/or need for dialysis more than 5 years. The prevalence of clinically diagnosed peripheral artery disease and aortoiliac stenosis and calcification of iliac arteries at CT angiographies were assessed. A multidisciplinary team evaluated the CT angiographies in regard to transplantability and surgery planning. Results In total, 470 potential kidney transplant candidates were included. Clinically diagnosed peripheral artery disease was present in 14%, aortoiliac stenosis in 16%, and iliac circular calcifications in 21% potential kidney transplant candidates. A change in clinical decision by the multidisciplinary team was recorded in 67 of 429 (16%) patients due to vascular findings including choice of side for implantation in 52 (12%) and transplant-ineligibility in 7 (2%). Six out of seven ineligible patients had clinically diagnosed peripheral artery disease. Any clinical decision-making was recorded in 178 (41%). Conclusion Systematic screening using aortoiliac CT angiography may guide the planning of transplant surgery in a large proportion of patients. The effect of transplant outcomes remains to be established.