Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Division of Nephrology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Transplantation. 2019 Oct;103(10):2164-2172. doi: 10.1097/TP.0000000000002635.
Patients with end-stage renal disease and aortoiliac stenosis are often considered ineligible for kidney transplantation, although kidney transplantation has been acknowledged as the best therapy for end-stage renal disease. The clinical outcomes of kidney transplantation in patients with aortoiliac stenosis are not well-studied. This study aimed to assess the impact of aortoiliac stenosis on graft and patient survival.
This retrospective, single-center study included kidney transplant recipients transplanted between January 1, 2000, and December 31, 2016, who received contrast-enhanced imaging. Patients with aortoiliac stenosis were classified using the Trans-Atlantic Inter-Society Consensus (TASC) II classification and categorized as having TASC II A/B lesions or having TASC II C/D lesions. Patients without aortoiliac stenosis were functioning as controls.
A total number of 374 patients was included in this study (n = 88 with TASC II lesions, n = 286 as controls). Death-censored graft survival was similar to the controls. Patient and uncensored graft survival was decreased in patients with TASC II C/D lesions (log-rank test P < 0.001). Patients with TASC II C/D lesions had a higher risk of 90-day mortality (hazard ratio, 3.96; 95% confidence interval, 1.12-14.04). In multivariable analysis, having a TASC II C/D lesion was an independent risk factor for mortality (hazard ratio, 3.25; 95% confidence interval, 1.87-5.67; P < 0.001). Having any TASC II lesion was not a risk factor for graft loss (overall P = 0.282).
Kidney transplantation in patients with TASC II A/B is feasible and safe without increased risk of perioperative mortality. TASC II C/D decreases patient survival. Death-censored graft survival is unaffected.
患有终末期肾病和主髂动脉狭窄的患者通常被认为不适合进行肾移植，尽管肾移植已被公认为治疗终末期肾病的最佳方法。主髂动脉狭窄患者肾移植的临床结果尚未得到充分研究。本研究旨在评估主髂动脉狭窄对移植物和患者生存的影响。
这是一项回顾性单中心研究，纳入了 2000 年 1 月 1 日至 2016 年 12 月 31 日期间接受过增强成像的接受肾移植的患者。根据跨大西洋内科学会共识（TASC）II 分类对主髂动脉狭窄患者进行分类，并分为 TASC II A/B 病变患者和 TASC II C/D 病变患者。无主髂动脉狭窄的患者作为对照组。
本研究共纳入 374 例患者（TASC II 病变患者 88 例，对照组 286 例）。死亡风险校正后的移植物存活率与对照组相似。TASC II C/D 病变患者的患者和未校正移植物存活率降低（对数秩检验 P < 0.001）。TASC II C/D 病变患者 90 天死亡率较高（风险比，3.96；95%置信区间，1.12-14.04）。多变量分析显示，存在 TASC II C/D 病变是死亡的独立危险因素（风险比，3.25；95%置信区间，1.87-5.67；P < 0.001）。存在任何 TASC II 病变不是移植物丢失的危险因素（总体 P = 0.282）。
TASC II A/B 的肾移植在没有增加围手术期死亡率的风险的情况下是可行和安全的。TASC II C/D 降低了患者的生存率。死亡风险校正后的移植物存活率不受影响。
