Pre-Transplant Assessment of Vascular Calcification as a Risk Factor of Mortality, Graft Loss, and Cardiovascular Events in Renal Transplant Recipients

• Published in: Transplantation proceedings 2015-10, Vol.47 (8), p.2368-2370
• Main Authors: Munguia, P, Caramelo, R, Rubio, M.V, Sahdalá, L, Arnaudas, L, Paul, J, Blasco, Á, Lou, L.M, Aladren, M.J, Sanjuan, A, Gutierrez-Dalmau, A
• Format: Article
• Language: English
• Subjects: Aged; Aorta, Abdominal - diagnostic imaging; Cardiovascular Diseases - epidemiology; Comorbidity; Diabetes Mellitus - epidemiology; Female; Graft Survival; Humans; Hypertension - epidemiology; Incidence; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - surgery; Kidney Transplantation; Male; Middle Aged; Mortality; Prognosis; Proportional Hazards Models; Radiography; Renal Dialysis; Retrospective Studies; Risk Factors; Surgery; Transplant Recipients; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2015.08.038

Abstract Background Vascular calcification (VC) is known as an independent predictor of mortality in patients undergoing hemodialysis; nevertheless, there is a lack of studies about the impact of vascular calcification in renal transplant recipients, and none of them use the Kauppila Index (KI) as a predictor of patient and graft prognosis. Methods We conducted an observational, retrospective study of 119 renal transplants, evaluating abdominal aortic calcifications (L4-S1) with the KI. We established 2 categories: absence (KI = 0–2) and presence (KI = 3–24) of VCs before transplantation. We analyzed the impact of calcification in graft and patient survival, new-onset diabetes mellitus, hypertension, cardiovascular events, renal function, and mineral metabolism. Results VCs were observed in 50 patients (42%) before renal transplantation. Patients with VCs were older, but no statistical differences were found in the pre-transplant study between sex, diabetes, body mass index, and cardiovascular events. We found a major patient survival (limited to first 2 years after transplantation), graft survival, and death-censored graft survival in those without VCs ( P  = .037, P  = .015, and P  = .023, respectively). In line with results, a higher incidence of major cardiovascular events (MACE) and cardiovascular death was observed in the group with preexisting calcification ( P  = .016/ P  = .019). In the multivariable analysis, VCs were not an independent predictor for graft loss, death-censored graft loss, or major cardiovascular events. Conclusions Simple evaluation of VCs with the use of the KI at the time of transplantation relates with graft and patient survival and with MACE after renal transplantation.