Plasma tissue-type plasminogen activator, fibrinogen, and time on dialysis prior to transplantation are related to carotid intima media thickness in renal transplant recipients

Abstract

The majority of deaths among patients after renal transplantation is attributed to cardiovascular disease (CVD). Intima media thickness (IMT) of the common carotid artery is related to coronary and cerebrovascular arterial disease. One of the major causes of death due to CVD is acute coronary syndrome, which is precipitated by coronary plaque rupture and subsequent thrombosis. The aim of the study was to evaluate associations between some fibrinolytic factors: antigens of tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), and thrombin-activatable fibrinolysis inhibitor (TAFI), and IMT in a population of renal transplant recipients. The study was performed on 33 Caucasian, clinically stable kidney transplant recipients (11 women, mean age 43 years, range 26 to 62 years). All the patients were on triple immunosuppressive regimen (cyclosporine, prednisone, and azathioprine) and had stable graft function (serum creatinine 1.7 ± 0.7 mg/dL). The mean time since transplantation was 49.9 months (range 4.1 to 131.8 months). In univariate analysis IMT correlated significantly with age ( r = .5; P = .001), pulse pressure (PP) ( r = .4; P = .05), time on dialysis prior to transplantation ( r = .6; P = .001), fibrinogen ( r = .4; P = .02), and t-PA ( r = .6; P = .001). Multiple regression analysis showed that t-PA antigen concentration ( P = .001), fibrinogen ( P < .05), and time on dialysis prior to transplantation ( P < .05) were positive independent predictors of IMT. These data support the concept of the coincidence of disturbances in fibrinolysis and arterial remodelling in patients after kidney transplantation. On the other hand the study shows that the duration of dialysis therapy before transplantation is detrimental to the arterial vasculature.