Hernández Domingo, Vázquez Teresa, Armas-Padrón Ana María, Alonso-Titos Juana, Casas Cristina, Gutiérrez Elena, Jironda Cristina, Cabello Mercedes, López Verónica
Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, IBIMA, REDinREN (RD16/0009/0006), Malaga, Spain.
La Cuesta Primary Healthcare Centre, La Laguna, Tenerife, Spain.
Transplantation. 2021 Jun 1;105(6):1188-1202. doi: 10.1097/TP.0000000000003518.
Peripheral vascular disease (PVD) is highly prevalent in patients on the waiting list for kidney transplantation (KT) and after transplantation and is associated with impaired transplant outcomes. Multiple traditional and nontraditional risk factors, as well as uremia- and transplant-related factors, affect 2 processes that can coexist, atherosclerosis and arteriosclerosis, leading to PVD. Some pathogenic mechanisms, such as inflammation-related endothelial dysfunction, mineral metabolism disorders, lipid alterations, or diabetic status, may contribute to the development and progression of PVD. Early detection of PVD before and after KT, better understanding of the mechanisms of vascular damage, and application of suitable therapeutic approaches could all minimize the impact of PVD on transplant outcomes. This review focuses on the following issues: (1) definition, epidemiological data, diagnosis, risk factors, and pathogenic mechanisms in KT candidates and recipients; (2) adverse clinical consequences and outcomes; and (3) classical and new therapeutic approaches.
外周血管疾病（PVD）在等待肾移植（KT）的患者以及肾移植后患者中极为普遍，并且与移植预后受损相关。多种传统和非传统危险因素，以及与尿毒症和移植相关的因素，影响着两个可能同时存在的过程，即动脉粥样硬化和动脉硬化，从而导致外周血管疾病。一些致病机制，如炎症相关的内皮功能障碍、矿物质代谢紊乱、脂质改变或糖尿病状态，可能促使外周血管疾病的发生和发展。在肾移植前后早期检测外周血管疾病、更好地理解血管损伤机制以及应用合适的治疗方法，都可以最大限度地减少外周血管疾病对移植预后的影响。本综述聚焦于以下问题：（1）肾移植候选者和受者的定义、流行病学数据、诊断、危险因素及致病机制；（2）不良临床后果和预后；（3）传统及新的治疗方法。
