Abstract
BackgroundAortic stiffness assessed by carotid-femoral pulse wave velocity (CF-PWV) is a predictor of mortality in several populations. However, little is known in kidney transplant recipients. Our objectives were to evaluate the ability of CF-PWV measured 3 months following transplantation to predict mortality, graft loss and its potential links to measured Glomerular Filtration Rate (mGFR) or kidney graft microvasculature parameters.MethodsThe study is based on a monocentric retrospective cohort including 220 adult kidney graft recipients evaluated three months after transplantation. CF-PWV measures, clinical, laboratory and histological data performed at 3 (M3) and 12 months (M12) following transplantation were retrospectively collected. The two primary endpoints were all-cause mortality and occurrence of end stage renal disease (ESRD) defined by initiation of dialysis.ResultsAfter a median follow up of 5.5 years [1.9; 8.8], death and graft loss occurred in 10 and 12 patients respectively. M3 CF-PWV was an independent mortality risk factor (HR = 1.29 [1.03; 1.61]; p = 0.03), despite no aortic stiffness variation during the first year of transplantation. Of notice, M3 CF-PWV was not associated with M12 mGFR or ESRD outcome. Graft microcirculation assessed by Banff vascular fibrous intimal thickening score (cv) worsened between M3 and M12 (p = 0.01), but no link was found with CF-PWV, mGFR or ESRD outcome. Surprisingly, acute rejections at M3 were associated after adjustment with mortality (p = 0.03) but not ESRD.ConclusionAortic stiffness measured 3 months after kidney transplantation is a strong predictor of mortality with no obvious influence on kidney graft microvasculature or graft loss.
Highlights
Chronic kidney disease (CKD) dramatically increases risk of cardiovascular morbidity and mortality
evaluation at 3 months (M3) carotid-femoral pulse wave velocity (CF-PWV) was not associated with evaluation at 12 months (M12) measured Glomerular Filtration Rate (mGFR) or end stage renal disease patients (ESRD) outcome
Microcirculation assessed by Banff vascular fibrous intimal thickening score worsened between M3 and M12 (p = 0.01), but no link was found with CF-PWV, mGFR or ESRD outcome
Summary
Chronic kidney disease (CKD) dramatically increases risk of cardiovascular morbidity and mortality. Cardiovascular death annual risk still remains 50-fold higher in transplant recipients compared to general population [3]. In this population, as well as in patients with end stage renal disease patients (ESRD), structural and functional modifications of large arteries are a striking feature, which may explain part of this important cardiovascular risk [4,5]. Arterial stiffness was reported as an independent predictive factor for coronary heart disease, fatal stroke, total and cardiovascular mortality in essential hypertensive [8,9,10], diabetic [11], and ESRD [12,13,14] populations. Aortic stiffness assessed by carotid-femoral pulse wave velocity (CF-PWV) is a predictor of mortality in several populations. Our objectives were to evaluate the ability of CF-PWV measured 3 months following transplantation to predict mortality, graft loss and its potential links to measured Glomerular Filtration Rate (mGFR) or kidney graft microvasculature parameters
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