[Vascular assessment of the receptor before kidney transplantation].

OBJECTIVES

To analyze the prevalence of vascular risk factors in patients with end-stage renal failure who are candidates to kidney transplantation, determine the efficacy of Doppler ultrasound and to develop a diagnostic vascular algorithm.

METHODS

The iliac, femoral, popliteal and posterior tibial arteries of 200 potential kidney graft recipients were evaluated by Doppler US. Patients were assessed for the following risk factors: hypertension, smoking, cholesterol and triglyceride levels, and obesity. Seventy of theses patients subsequently received a kidney allograft. A biopsy of the iliac artery was performed at the level of the arteriotomy.

RESULTS

Hypertension (72%), smoking (47%), obesity, hypercholesterolemia and hyperlipidemia (7%) were the most prevalent risk factors. Atherosclerosis was histologically demonstrated in 19.2%: 80% were fibrous plaques. The atherosclerotic arteries showed peak systolic and diastolic flows significantly lower than those of normal arteries (p < 0.05). The resistance index was higher in the atherosclerotic arteries (p < 0.01). The number of cigarettes (R = -0.78) and cholesterol levels (R = -0.43) correlated inversely with the peak flows in the posterior tibial artery.

CONCLUSIONS

Vascular evaluation of kidney graft recipients is fundamental. Claudication, hypertension, age > 60 years, asymmetrical pulses and femorobrachial index < 0.7 are indications for performing ultrasound evaluation prior to kidney transplantation.