The prognosis of kidney transplant recipients with aorto‐iliac calcification: a systematic review and meta‐analysis

Abstract

The prognosis of kidney transplant recipients (KTR) with vascular calcification (VC) in the aorto-iliac arteries is unclear. We performed a systematic review and meta-analysis to investigate their survival outcomes. Studies from January 1st, 2000 until March 5th, 2019 were included. Outcomes for meta-analysis were patient survival, (death-censored) graft survival and delayed graft function (DGF). Twenty-one studies were identified, eight provided data for meta-analysis. KTR with VC had a significantly increased mortality risk [1-year: risk ratio (RR) 2.19 (1.39-3.44), 5-year: RR 2.28 (1.86-2.79)]. The risk of 1-year graft loss was three times higher in recipients with VC [RR 3.15 (1.30-7.64)]. The risk of graft loss censored for death [1-year: RR 2.26 (0.58-2.73), 3-year: RR 2.19 (0.49-9.82)] and the risk of DGF (RR 1.24, 95% CI 0.98-1.58) were not statistically different. The quality of the evidence was rated as very low. To conclude, the presence of VC was associated with an increased mortality risk and risk of graft loss. In this small sample size, no statistical significant association between VC and DGF or risk of death-censored graft loss could be demonstrated. For interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.

Aorto-Iliac Artery Calcification Prior to Kidney Transplantation

“…The literature on abdominal aorta calcification (AAC) assessment by plain pelvic X-ray or dual X-ray absorptiometry, using visual grading scales, is more extensive [13]. Studies evaluating this method showed results similar to our findings, with significant associations of a high-AAC with all-cause mortality and cardiovascular events in multivariable Cox regression analyses [12,20,21].…”

“…Prior studies have identified imaging-proven vascular calcification as a prognostic factor for inferior survival and cardiovascular events in kidney transplant recipients [12,13]. For the applied imaging studies, a distinction can be made between coronary artery calcification (CAC) and aorto-iliac calcification, as well as between assessment of calcification prior to and after transplantation.…”

Selective screening imaging of the aortoiliac arterial system in kidney transplant candidates with non‐contrast pelvic computed tomography

“…While there are data to formulate life prognosis for patients with heart disease or femoropopliteal disease, specific survival data in patients with iliac disease are scarce. There is some evidence that severe calcifications in the infrarenal aorta and the iliac arteries are associated with higher mortality with a functioning graft, major vascular events after kidney transplantation, 4 and cardiovascular morbidity and mortality in the dialysis patient population 5‐11 …”

“…There is some evidence that severe calcifications in the infrarenal aorta and the iliac arteries are associated with higher mortality with a functioning graft, major vascular events after kidney transplantation, 4 and cardiovascular morbidity and mortality in the dialysis patient population. [5][6][7][8][9][10][11] Conventional arteriograms have not had a significant role as a screening tool in kidney transplant evaluation. CT angiograms have replaced conventional angiograms, as they are less invasive, but they still require intravenous contrast administration and deliver significant radiation exposure.…”

Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

“…The vessels of the pancreatic graft are anastomosed to the recipient's iliac vessels. It is known that calcification of these vessels can increase graft loss and even mortality risk post-transplantation [63,64]. Unexpectedly finding a calcified vessel intra-operatively may delay the ischemic time of the graft organ and the length of the operation.…”