Usefulness of pretransplant aortic arch calcification evaluation for kidney transplant outcome prediction in one year follow-up

Abstract

Vascular calcification (VC) is linked to post-transplant cardiovascular events and hypercalcemia which may influence kidney graft function in the long term. We aimed to evaluate whether pretransplant aortic arch calcification (AoAC) can predict post-transplant cardiovascular or cerebrovascular events (CVEs), and to assess its association with post-transplant plasma calcium levels and renal function in one-year follow-up. Our single-center observational prospective study enrolled 37 kidney transplant recipients (KTR) without previous history of vascular events. Two radiologists evaluated pretransplant AoAC on chest X-ray as suggested by Ogawa et al. in 2009. Cohen’s kappa coefficient was 0.71. The mismatching results were repeatedly reviewed and resulted in consensus. Carotid-femoral (cfPWV) and carotid-radial pulse wave velocity (crPWV) was measured using applanation tonometry before and one year after transplantation. Patient clinical, biochemical data, and cardiovascular/CVE rate were monitored within 1 year. We found out that eGFR_1year correlated with eGFR_discharge and calcium based on hospital discharge data (β = 0.563, p = .004 and β = 51.360, p = .026, respectively). Multivariate linear regression revealed that donor age, donor gender, and recipient eGFR_discharge (R-squared 0.65, p = .002) better predict eGFR_1year than AoAC combined with recipient eGFR_discharge (R-squared 0.35, p = .006). During 1-year follow-up, four (10.81%) patients experienced cardiovascular events, which were predicted by PWV ratio (HR 7.549, p = .045), but not related to AoAC score (HR 1.044, p = .158). In conclusion, KTR without previous vascular events have quite low cardiovascular/CVE rate within 1-year follow-up. VC evaluated as AoAC on pretransplant chest X-ray together with recipient eGFR_discharge could be related to kidney function in one-year follow-up.

Keywords:

• Kidney transplantation
• aortic arch calcification
• aortic stiffness
• cardiovascular events
• kidney graft function

Acknowledgements

We thank Dr. Tetsuya Ogawa from Division of Blood Purification and Nephrology Department of Medicine, Tokyo Women's Medical University Medical Center, for providing information about practical use of AoAC scale. Many thanks for Vilnius University Hospital Santaros Clinics, Centre of Nephrology nurses for blood sample collecting.

Disclosure statement

No potential conflict of interest was reported by the authors.