CAROTID ATHEROSCLEROSIS IN RENAL TRANSPLANT RECIPIENTS

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{tit}REPLY TO THE LETTER BY DRS. MASSY, DRÜEKE, AND KREIS {sal}&NA; In this issue of Transplantation, Massy and colleagues debate the final statement of our article (1) that carotid lesions may represent a useful predictive marker of clinical events in nontransplant patients and, therefore, carotid artery evaluation by B-mode ultrasound might be routinely included in the management of renal transplant patients. They support their criticism by recent prospective data, which did not show any association between such lesions and cardiovascular events (2). In this article, despite a significant univariate difference in carotid plaque prevalence between patients having a clinical event during the follow up (n=9) and patients who did not (n=70) (respectively 21% vs. 4%, p =0.03), they found independent associations only with diabetes and plasma cholesterol levels (2). In our experience, the results are similar. We had a five-fold increase (odds ratio 5.04, 95% CI 0.56–48.27) in the risk of developing a major cardiovascular event in renal transplant recipients with intima media thickness or plaque, which was not statistically significant for the low number of events (n=5), and, for this reason, we have not yet published this finding. However, we based our proposal on both data from literature and personal findings in other groups of patients. If some studies failed to demonstrate associations between carotid lesions and clinical events, many others strongly support this relationship (3, 4). Moreover, in a 4-year follow up we found independent relationships between carotid damage and major cardiovascular endpoints in hypercholesterolemic patients (Averna MR et al., unpublished observations). Because many renal transplant recipients have carotid lesions of different degrees, we believe that the evaluation of carotid arteries by B-mode ultrasound, which represents an accurate, direct, and noninvasive diagnostic method, may be useful for selecting those patients with the highest possibility to develop a major cardiovascular event, and, therefore, this method should be routinely included in the management of such patients. Tilman B. Drüeke Henri Kreis Carlo M. Barbagallo1 Antonio Pinto Maurizio R. Averna Vito Sparacino