Cofan F, Arias M, Nuñez I, Cofan M, Corbella E, Rosich E, Zambón D, Ros E, Gilabert R, Oppenheimer F, Campistol J M
Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Transplant Proc. 2007 Sep;39(7):2236-8. doi: 10.1016/j.transproceed.2007.06.062.
Carotid arteriosclerosis is a marker of cardiovascular risk in the general population. Cardiovascular disease is highly prevalent in kidney transplant recipients. This study analyzed the impact of arteriosclerotic carotid lesions on the evolution of renal transplant recipients.
This prospective study was performed in 70 patients with renal transplantations (mean age 52 +/- 12 years; 67% men (n = 47). High-resolution B-mode ultrasonography (7.5 MHz) of both carotid arteries was performed at baseline to assess carotid caliber, mean and maximum intima-media thickness (IMT), presence of arteriosclerotic plaques (number and maximum height), and percentage stenosis. We analyzed the impact of carotid arteriosclerosis and various donor-recipient clinical covariables on long-term patient and graft survival.
Mean follow-up was 9.7 +/- 2.5 years (2-14). Atheroma plaques were detected in 74% of patients (n = 52). The mean number of plaques was 3.96 +/- 2.88 and maximum plaque height was 2.49 +/- 0.97 mm. IMT was 0.71 +/- 0.21 mm (0.4-1.5) with 27% of patients (n = 19) having an IMT value greater than 0.8 mm. Sonographic signs of occlusion were evident in 13% (n = 9) and the mean occlusion was 33 +/- 11% (range 20%-45%). The presence of plaques was significantly associated with age (P = .002), hypertension and diabetes (P = .016), and hypercholesterolemia (P = .01). There was an association between age and arterial wall thickness (P = .042). Acute rejection was an independent risk factor for graft loss (OR 8.14, P = .003). The multivariate study identified carotid wall thickness as an independent risk factor for patient death (OR 12.7, P = .017).
Carotid arteriosclerosis is highly prevalent among renal transplant recipients. Carotid lesions were an independent risk factor for long-term patient death. High-resolution ultrasound imaging of the carotid arteries was a useful, noninvasive diagnostic technique for accurate assessment of cardiovascular risk in renal transplant recipients.
颈动脉粥样硬化是普通人群心血管风险的一个标志物。心血管疾病在肾移植受者中高度流行。本研究分析了动脉粥样硬化性颈动脉病变对肾移植受者病情发展的影响。
本前瞻性研究纳入了70例肾移植患者（平均年龄52±12岁；67%为男性（n = 47））。在基线时对双侧颈动脉进行高分辨率B型超声检查（7.5 MHz），以评估颈动脉管径、平均和最大内膜中层厚度（IMT）、动脉粥样硬化斑块的存在情况（数量和最大高度）以及狭窄百分比。我们分析了颈动脉粥样硬化和各种供受者临床协变量对患者和移植物长期存活的影响。
平均随访时间为9.7±2.5年（2 - 14年）。74%的患者（n = 52）检测到动脉粥样硬化斑块。斑块的平均数量为3.96±2.88个，最大斑块高度为2.49±0.97毫米。IMT为0.71±0.21毫米（0.4 - 1.5），27%的患者（n = 19）IMT值大于0.8毫米。13%的患者（n = 9）有明显的超声闭塞征象，平均闭塞率为33±11%（范围20% - 45%）。斑块的存在与年龄（P = .002）、高血压和糖尿病（P = .016）以及高胆固醇血症（P = .01）显著相关。年龄与动脉壁厚度之间存在关联（P = .042）。急性排斥是移植物丢失的独立危险因素（OR 8.14，P = .003）。多变量研究确定颈动脉壁厚度是患者死亡的独立危险因素（OR 12.7，P = .017）。
颈动脉粥样硬化在肾移植受者中高度流行。颈动脉病变是患者长期死亡的独立危险因素。颈动脉高分辨率超声成像对于准确评估肾移植受者的心血管风险是一种有用的非侵入性诊断技术。
