Division of Nephrology and Hypertension, Centre Hospitalier du Nord, Zgharta, Lebanon.
Nephrol Dial Transplant. 2012 May;27(5):2095-100. doi: 10.1093/ndt/gfr578. Epub 2011 Oct 6.
Cardiovascular (CV) risk remains high in renal transplant patients despite a clear improvement conferred by transplantation. This risk is attributed mostly to recipient-related risk factors. Donor vascular characteristics, such as arterial stiffness, have been poorly investigated in this regard.
Recipients of living-related (n = 75) and living-unrelated (n = 20) kidney grafts were recruited at a mean time of 107 ± 41 months after transplantation for baseline evaluation and follow-up for the occurrence of the following composite outcome: myocardial infarction, stroke, CV death, doubling of serum creatinine or development of end-stage renal disease (ESRD). At inclusion, recipients and their corresponding donors underwent complete history, physical examination, laboratory tests and non-invasive measurement of aortic pulse wave velocity (PWV).
During a mean follow-up of 56 ± 18 months, 20 recipients doubled their serum creatinine, of whom 16 reached ESRD, and 9 suffered of a new CV event (5 of which were fatal). Cox proportional hazards regression analysis showed that, in addition to recipient-related parameters, such as the presence of CV event and the estimated glomerular filtration rate at inclusion, donor aortic PWV was a strong and independent predictor of the composite recipient outcome.
Donor large artery stiffness may predict recipient CV and graft outcome. This finding demonstrates the tight link that exists between the vascular system and the kidneys and suggests that donor contribution to recipient outcome goes beyond simple parameters like age, gender and even familial or non-familial donor type.
尽管移植后心血管（CV）风险明显改善，但肾移植患者的 CV 风险仍然很高。这种风险主要归因于受者相关的危险因素。在这方面，供体血管特征（如动脉僵硬度）的研究甚少。
在移植后平均 107 ± 41 个月时，招募了活体相关（n = 75）和活体无关（n = 20）肾移植受者进行基线评估和随访，以观察以下复合结局的发生：心肌梗死、中风、CV 死亡、血清肌酐加倍或终末期肾病（ESRD）的发展。纳入时，受者及其相应的供者接受了完整的病史、体格检查、实验室检查和主动脉脉搏波速度（PWV）的非侵入性测量。
在平均 56 ± 18 个月的随访期间，20 名受者血清肌酐加倍，其中 16 名达到 ESRD，9 名发生新的 CV 事件（其中 5 例为致命性）。Cox 比例风险回归分析表明，除了受者相关参数（如 CV 事件和纳入时估计的肾小球滤过率）外，供体主动脉 PWV 也是复合受者结局的一个强有力的独立预测因素。
供体大动脉僵硬度可能预测受者 CV 和移植物结局。这一发现表明血管系统与肾脏之间存在紧密联系，并表明供体对受者结局的贡献超出了年龄、性别甚至家族或非家族供体类型等简单参数。
