Nephrology Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
Institut National de la Santé et de la Recherche Médicale U970-PARCC, Paris, France.
J Am Heart Assoc. 2017 Sep 9;6(9):e006078. doi: 10.1161/JAHA.117.006078.
Chronic kidney disease is characterized by stiffening, thinning, dilatation, and increased circumferential wall stress of large arteries, associated with increased cardiovascular risk. Kidney transplantation (KT) reverses many pathological features of chronic kidney disease and improves life expectancy; however, longitudinal studies exploring the impact of KT on recipient large arteries are scarce.
This study was designed to appraise arterial changes following KT. Carotid-femoral pulse wave velocity, carotid remodeling (circumferential wall stress and carotid internal diameter), and stiffness were measured in 161 consecutive recipients receiving either a living (n=49) or a deceased (n=112) donor allograft, at 3 and 12 months after transplantation. Mean pulse wave velocity decreased from 10.8 m/s (95% confidence interval, 10.5-11.2 m/s) (at month 3) to 10.1 m/s (95% confidence interval, 9.8-10.5 m/s) (at month 12) (<0.001). After multivariate adjustment, pulse wave velocity reduction from month 3 to month 12 was significantly larger in the living donor allograft KT (<0.001). Circumferential wall stress decreased, 70 kPa (95% confidence interval, 68-72 kPa) to 64 kPa (95% confidence interval, 62-67 kPa), as well as carotid internal diameter and carotid stiffness (<0.001 for all). Reductions in circumferential wall stress, diameter, and stiffness were significantly larger in the living donor allograft KT (<0.001). When deceased donor allograft patients were classified into standard and expanded criteria donors, changes in both pulse wave velocity and circumferential wall stress were blunted in expanded criteria donors. Changes were independent of graft function and blood pressure changes.
Large-artery stiffness and maladaptive carotid artery remodeling of chronic kidney disease is partially reversed within 12 months of KT and appears unrelated to renal function. Improvements were independently associated with live organ donation. Our data suggest that expanded criteria donors may hamper vascular recovery.
慢性肾脏病的特征是大动脉僵硬、变薄、扩张和周向壁应力增加，伴发心血管风险增加。肾移植（KT）逆转了慢性肾脏病的许多病理特征，并提高了预期寿命；然而，探索 KT 对受者大动脉影响的纵向研究却很少。
本研究旨在评估 KT 后的动脉变化。在 161 例连续接受活体（n=49）或尸肾（n=112）供体移植的受者中，测量颈动脉-股动脉脉搏波速度、颈动脉重塑（周向壁应力和颈动脉内直径）和僵硬程度，分别在移植后 3 个月和 12 个月进行。平均脉搏波速度从 10.8 m/s（95%置信区间，10.5-11.2 m/s）（移植后 3 个月）降至 10.1 m/s（95%置信区间，9.8-10.5 m/s）（移植后 12 个月）（<0.001）。经多变量调整后，活体供体移植 KT 从第 3 个月到第 12 个月的脉搏波速度下降幅度明显更大（<0.001）。周向壁应力从 70 kPa（95%置信区间，68-72 kPa）下降至 64 kPa（95%置信区间，62-67 kPa），颈动脉内直径和颈动脉僵硬度也下降（均<0.001）。活体供体移植 KT 的周向壁应力、直径和僵硬度的降低幅度明显更大（均<0.001）。当将尸肾供体受者分为标准和扩展标准供体时，在扩展标准供体中，脉搏波速度和周向壁应力的变化均减弱。变化与移植物功能和血压变化无关。
慢性肾脏病患者的大动脉僵硬和颈动脉重塑不良在 KT 后 12 个月内部分逆转，与肾功能无关。改善与活体器官捐献独立相关。我们的数据表明，扩展标准供体可能会阻碍血管恢复。
