Benjamens Stan, Alghamdi Saleh Z, Rijkse Elsaline, Te Velde-Keyzer Charlotte A, Berger Stefan P, Moers Cyril, de Borst Martin H, Slart Riemer H J A, Dor Frank J M F, Minnee Robert C, Pol Robert A
Department of Surgery, Division of Transplant Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
J Clin Med. 2021 Jan 17;10(2):325. doi: 10.3390/jcm10020325.
While the association of vascular calcification with inferior patient outcomes in kidney transplant recipients is well-established, the association with graft outcomes has received less attention. With this dual-centre cohort study, we aimed to determine the clinical impact of recipient pre-transplant aorto-iliac calcification, measured on non-contrast enhanced computed tomography (CT)-imaging within three years prior to transplantation (2005-2018). We included 547 patients (61.4% male, age 60 (interquartile range 51-68) years), with a median follow-up of 3.1 (1.4-5.2) years after transplantation. The aorto-iliac calcification score (CaScore) was inversely associated with one-year estimated-glomerular filtration rate (eGFR) in univariate linear regression analysis (standard β -3.3 (95% CI -5.1 to -1.5, < 0.0001), but not after adjustment for potential confounders, including donor and recipient age ( = 0.077). In multivariable Cox regression analyses, a high CaScore was associated with overall graft failure ( = 0.004) and death with a functioning graft ( = 0.002), but not with death-censored graft failure and graft function decline. This study demonstrated that pre-transplant aorto-iliac calcification is associated with one-year eGFR in univariate, but not in multivariable linear regression analyses. Moreover, this study underlines that transplantation in patients with a high CaScore does not result in earlier transplant function decline or worse death censored graft survival, although ongoing efforts for the prevention of death with a functioning graft remain essential.
虽然血管钙化与肾移植受者较差的患者预后之间的关联已得到充分证实，但与移植肾预后的关联却较少受到关注。通过这项双中心队列研究，我们旨在确定移植前受者腹主动脉-髂动脉钙化的临床影响，该钙化通过移植前三年（2005 - 2018年）内的非增强计算机断层扫描（CT）成像进行测量。我们纳入了547例患者（男性占61.4%，年龄60岁（四分位间距51 - 68岁）），移植后中位随访时间为3.1（1.4 - 5.2）年。在单变量线性回归分析中，腹主动脉-髂动脉钙化评分（CaScore）与一年估计肾小球滤过率（eGFR）呈负相关（标准β -3.3（95%CI -5.1至-1.5，<0.0001）），但在对包括供体和受体年龄等潜在混杂因素进行调整后则不然（P = 0.077）。在多变量Cox回归分析中，高CaScore与总体移植肾失败（P = 0.004）和移植肾存活时死亡（P = 0.002）相关，但与死亡删失的移植肾失败和移植肾功能下降无关。这项研究表明，在单变量线性回归分析中，移植前腹主动脉-髂动脉钙化与一年eGFR相关，但在多变量线性回归分析中则不然。此外，这项研究强调，CaScore高的患者进行移植不会导致移植肾功能更早下降或死亡删失的移植肾存活情况更差，尽管持续努力预防移植肾存活时死亡仍然至关重要。
