Impact of Carotid Atherosclerosis as Assessed by B-Mode Ultrasonography on the Evolution of Kidney Transplantation

Abstract

Carotid arteriosclerosis is a marker of cardiovascular risk in the general population. Cardiovascular disease is highly prevalent in kidney transplant recipients. This study analyzed the impact of arteriosclerotic carotid lesions on the evolution of renal transplant recipients. Methods This prospective study was performed in 70 patients with renal transplantations (mean age 52 ± 12 years; 67% men ( n = 47). High-resolution B-mode ultrasonography (7.5 MHz) of both carotid arteries was performed at baseline to assess carotid caliber, mean and maximum intima-media thickness (IMT), presence of arteriosclerotic plaques (number and maximum height), and percentage stenosis. We analyzed the impact of carotid arteriosclerosis and various donor-recipient clinical covariables on long-term patient and graft survival. Results Mean follow-up was 9.7 ± 2.5 years (2–14). Atheroma plaques were detected in 74% of patients ( n = 52). The mean number of plaques was 3.96 ± 2.88 and maximum plaque height was 2.49 ± 0.97 mm. IMT was 0.71 ± 0.21 mm (0.4–1.5) with 27% of patients ( n = 19) having an IMT value greater than 0.8 mm. Sonographic signs of occlusion were evident in 13% ( n = 9) and the mean occlusion was 33 ± 11% (range 20%–45%). The presence of plaques was significantly associated with age ( P = .002), hypertension and diabetes ( P = .016), and hypercholesterolemia ( P = .01). There was an association between age and arterial wall thickness ( P = .042). Acute rejection was an independent risk factor for graft loss (OR 8.14, P = .003). The multivariate study identified carotid wall thickness as an independent risk factor for patient death (OR 12.7, P = .017). Conclusion Carotid arteriosclerosis is highly prevalent among renal transplant recipients. Carotid lesions were an independent risk factor for long-term patient death. High-resolution ultrasound imaging of the carotid arteries was a useful, noninvasive diagnostic technique for accurate assessment of cardiovascular risk in renal transplant recipients.