Cardiovascular Disease in Early Kidney Transplantation: Comparison Between Living and Deceased Donor Recipients

“…Although we did not collect data on the duration of hemodialysis, a previous study documented a shorter duration of hemodialysis to clinical manifestation of coronary artery disease in hemodialysis patients with DM than in those without DM 20. Dialysis vintage has been shown to predict progression of vascular calcification 28. Therefore, a shorter hemodialysis duration before CTO‐PCI would result in immaturity of the CTO lesion, and this might partly explain the positive impact of DM on the technical results of CTO‐PCI in hemodialysis patients.…”

Section: Discussionmentioning

confidence: 97%

Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

Nakatani

Kohsaka

Yamane³

et al. 2017

JAHA

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BackgroundAmong patients treated with percutaneous coronary intervention for chronic total occlusion (CTO‐PCI), patients on long‐term hemodialysis are at significantly high risk for cardiovascular mortality and morbidity. However, clinical or angiographic predictors that might aid in better patient selection remain unclear. We aimed to assess the acute impact of hemodialysis in patients who underwent CTO‐PCI.Methods and ResultsThe Retrograde Summit registry is a multicenter, prospective registry of patients undergoing CTO‐PCI at 65 Japanese centers. Patient characteristics and procedural outcomes of 4749 patients were analyzed, according to the presence (n=313) or absence (n=4436) of baseline hemodialysis. A prediction model for technical failure among hemodialysis patients was also developed. The technical success rate of CTO‐PCI was significantly lower in hemodialysis than in nonhemodialysis patients (78.0% versus 89.1%, P<0.001). The rates of in‐hospital major adverse cardiac and cerebrovascular events were similar between the 2 groups (1.6% versus 0.9%, P=0.24). Irrespective of clinical/angiographic characteristics or previously developed scoring systems, hemodialysis independently predicted technical failure for CTO‐PCI. Among hemodialysis patients, predictors of technical failure were blunt stump (odds ratio 2.45, 95% confidence interval, 1.15–5.21, P=0.021), severe lesion calcification (odds ratio 2.50, 95% confidence interval, 1.19–5.24, P=0.015), and absence of diabetes mellitus (odds ratio 3.15, 95% confidence interval, 1.49–6.64, P=0.003). In hemodialysis patients without these predictors, the technical success rate was 96.2%.ConclusionsHemodialysis is significantly associated with technical failure. Contemporary CTO‐PCI seems feasible and safe in selected hemodialysis patients.

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“…Compared to DDRT, LDRT had a lower relative risk (versus those remaining on dialysis) for AMI both early (≤3 months) and late (>3 months) post-transplantation [142]. Another recent cross-sectional study from Brazil also demonstrated a significantly higher prevalence of CVD in terms of left ventricular hypertrophy, coronary vascular calcification, and arrhythmia in the first 2 months post-transplant in DDRT as compared to LDRT; however, these differences did not exist when adjusted for age and dialysis vintage [143]. Elderly recipients generally carry multiple comorbid conditions and are at higher risk for perioperative mortality than younger recipients.…”

Section: Elderly and Frailtymentioning

confidence: 95%

Living Donation Mitigates Poorer Outcomes in Marginal Recipients

2016

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Increasing the number of kidney transplantations results in the trend toward the utilization of marginal but acceptable kidneys for deceased donor renal transplantations (DDRT). At the same time, the acceptance of recipients with high medical, surgical, immunological, or psychosocial risks of poor transplant outcomes as we refer to here as "marginal recipients" has been increasing. The combination of both a low quality donor kidney and marginal kidney transplant recipient leads to unfavorable outcomes during the peri-and post-transplant periods. Since some of the risk factors are non-modifiable, living donor renal transplantation (LDRT)with high-quality kidneys and a well-planned operation could potentially mitigate unfavorable outcomes in high risk marginal recipients. In this article, we review common comorbid conditions and risk factors in marginal recipients. We then discuss the different outcomes between DDRT and LDRT in marginal recipients during the perioperative period and suggest potential strategies for utilizing living kidney organs to mitigate the poor outcomes of DDRT.

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Cardiovascular Disease in Early Kidney Transplantation: Comparison Between Living and Deceased Donor Recipients

Cited by 16 publications

References 33 publications

Metabolic Profile and Cardiovascular Risk in a Population of Renal Transplant Recipients

Metabolic Profile and Cardiovascular Risk in a Population of Renal Transplant Recipients

Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

Living Donation Mitigates Poorer Outcomes in Marginal Recipients

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