Salib Madonna, Simon Arnaud, Girerd Nicolas, Kearney-Schwartz Anna, Rossignol Patrick, Benetos Athanase, Frimat Luc, Girerd Sophie
Centre d'Investigations Cliniques-1433, Université de Lorraine, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, 54000 Nancy, France.
Nephrology Department, University Hospital of Nancy, 54500 Vandoeuvre les Nancy, France.
J Clin Med. 2022 Mar 4;11(5):1410. doi: 10.3390/jcm11051410.
(1) Background: Increased arterial stiffness is associated with cardiovascular (CV) diseases in end-stage renal disease (ESRD) patients, and CV mortality remains higher in kidney transplantation (KT) recipients compared to in the general population. KT is associated with an improvement in arterial stiffness in the early post-transplant period, followed by a potential re-worsening in the late period. In a cohort of KT patients, we evaluated the associations of pulse-wave velocity (PWV) measured at different time-points (pre-transplant, and early and late post-transplant periods) with CV morbi-mortality, as well as the evolution between these measurements with CV morbi-mortality. (2) Methods: Forty KT recipients with a 10-year follow-up were included. The association of PWV with CV events was assessed with multivariable cox analysis. Backward linear regressions were conducted to identify the determinants of PWV at 1 year and those of the long-term evolution of PWV after KT (delta PWV at 1 year—latest PWV). (3) Results: The absence of arterial stiffening during the long-term follow-up after KT is associated with a lower CV outcome rate (HR for the delta PWV = 0.76 (0.58−0.98), p = 0.036). Age at KT is associated with the worsening of arterial stiffness in the late post-transplantation period (β for the delta PWV = −0.104, p = 0.031). A high PWV at 1 year was associated with a potential for recovery during follow-up (β = 0.744, p < 0.0001). (4) Conclusions: The absence of PWV worsening in the late post-transplantation period was significantly associated with a lower risk of CV events, whereas early changes in PWV were not. Finding an intervention capable of reducing long-term PWV could improve the prognosis of KT recipients.
（1）背景：动脉僵硬度增加与终末期肾病（ESRD）患者的心血管（CV）疾病相关，与普通人群相比，肾移植（KT）受者的心血管死亡率仍然更高。KT与移植后早期动脉僵硬度的改善相关，随后在后期可能再次恶化。在一组KT患者中，我们评估了在不同时间点（移植前、移植后早期和晚期）测量的脉搏波速度（PWV）与心血管病死亡率的关联，以及这些测量值之间的变化与心血管病死亡率的关系。（2）方法：纳入40例接受10年随访的KT受者。采用多变量Cox分析评估PWV与心血管事件的关联。进行向后线性回归以确定1年时PWV的决定因素以及KT后PWV长期变化的决定因素（1年时的PWV变化值 - 最新PWV）。（3）结果：KT后长期随访期间无动脉僵硬度增加与较低的心血管结局发生率相关（PWV变化值的HR = 0.76（0.58 - 0.98），p = 0.036）。KT时的年龄与移植后期动脉僵硬度的恶化相关（PWV变化值的β = -0.104，p = 0.031）。1年时高PWV与随访期间恢复的可能性相关（β = 0.744，p < 0.0001）。（4）结论：移植后期PWV无恶化与较低的心血管事件风险显著相关，而PWV的早期变化则不然。找到一种能够降低长期PWV的干预措施可能会改善KT受者的预后。
