Abstract
While the association of vascular calcification with inferior patient outcomes in kidney transplant recipients is well-established, the association with graft outcomes has received less attention. With this dual-centre cohort study, we aimed to determine the clinical impact of recipient pre-transplant aorto-iliac calcification, measured on non-contrast enhanced computed tomography (CT)-imaging within three years prior to transplantation (2005–2018). We included 547 patients (61.4% male, age 60 (interquartile range 51–68) years), with a median follow-up of 3.1 (1.4–5.2) years after transplantation. The aorto-iliac calcification score (CaScore) was inversely associated with one-year estimated-glomerular filtration rate (eGFR) in univariate linear regression analysis (standard β −3.3 (95% CI −5.1 to −1.5, p < 0.0001), but not after adjustment for potential confounders, including donor and recipient age (p = 0.077). In multivariable Cox regression analyses, a high CaScore was associated with overall graft failure (p = 0.004) and death with a functioning graft (p = 0.002), but not with death-censored graft failure and graft function decline. This study demonstrated that pre-transplant aorto-iliac calcification is associated with one-year eGFR in univariate, but not in multivariable linear regression analyses. Moreover, this study underlines that transplantation in patients with a high CaScore does not result in earlier transplant function decline or worse death censored graft survival, although ongoing efforts for the prevention of death with a functioning graft remain essential.
Highlights
IntroductionKidney graft outcomes can be divided in short-term outcomes, such as early failure or one-year graft function, and long-term outcomes, such as (death-censored) graft failure and graft function decline [4]
In the first year of follow-up, laboratory values (n = 462) of the CaScore groups differed for estimated-glomerular filtration rate (eGFR) at six-months and one-year, calcium, phosphate, glucose, PTH, and urinary protein excretion (Table 1)
For short-term graft outcomes, more early graft failure events were observed in the high compared to the low CaScore group (n = 9 (4.9) vs. n = 5 (1.4), p = 0.027), but no differences in delayed graft function or acute rejections (Table 2)
Summary
Kidney graft outcomes can be divided in short-term outcomes, such as early failure or one-year graft function, and long-term outcomes, such as (death-censored) graft failure and graft function decline [4]. Death-censored graft failure, as return to dialysis or retransplantation, is seen in 10–12.5% of kidney transplant recipients at 5–6.2 years after transplantation [5,6]. Overall graft failure, including death with a functioning graft, is seen at a rate of 5% each year of follow-up, of which 40–60% is attributed to death with a functioning graft [7,8,9,10,11]. As doubling of serum creatinine or graft failure, is seen in 18.8% of kidney transplant recipients at 5.4 years after transplantation [12]
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