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Pre-Transplant Assessment of Vascular Calcification as a Risk Factor of Mortality, Graft Loss, and Cardiovascular
P Munguia1, R Caramelo1, M V Rubio1
1Department of Nephrology, Hospital Universitario Miguel Servet, Grupo ERC ARAGON, IACS, Zaragoza, Spain.
Insights
Vascular calcification (VC) before kidney transplant impacts patient and graft survival. Early detection using the Kauppila Index (KI) can predict outcomes and cardiovascular events post-transplant.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Vascular calcification (VC) is a known mortality predictor in hemodialysis patients.
- Limited research exists on VC's impact in renal transplant recipients.
- The Kauppila Index (KI) has not been used to predict prognosis in this population.
Purpose of the Study:
- To evaluate the impact of pre-transplant vascular calcification (VC) on renal transplant recipients.
- To assess VC's predictive value for patient and graft survival using the Kauppila Index (KI).
- To analyze the association of VC with cardiovascular events and graft function.
Main Methods:
- Observational, retrospective study of 119 renal transplant recipients.
- Abdominal aortic calcifications (L4-S1) assessed using the Kauppila Index (KI).
- Patients categorized into absence (KI=0-2) and presence (KI=3-24) of VC before transplantation.
Main Results:
- Vascular calcification (VC) was present in 42% of patients pre-transplant.
- Patients without VC showed significantly better patient survival (first 2 years), graft survival, and death-censored graft survival.
- Pre-existing VC was associated with a higher incidence of major adverse cardiovascular events (MACE) and cardiovascular death.
Conclusions:
- Simple evaluation of vascular calcification (VC) using the Kauppila Index (KI) at transplantation correlates with graft and patient survival.
- VC assessment at transplantation is linked to major adverse cardiovascular events (MACE) post-transplant.
- While associated, VC was not an independent predictor for graft loss or MACE in multivariable analysis.
Background:
Vascular calcification (VC) is known as an independent predictor of mortality in patients undergoing hemodialysis; nevertheless, there is a lack of studies about the impact of vascular calcification in renal transplant recipients, and none of them use the Kauppila Index (KI) as a predictor of patient and graft prognosis.
Methods:
We conducted an observational, retrospective study of 119 renal transplants, evaluating abdominal aortic calcifications (L4-S1) with the KI. We established 2 categories: absence (KI = 0-2) and presence (KI = 3-24) of VCs before transplantation. We analyzed the impact of calcification in graft and patient survival, new-onset diabetes mellitus, hypertension, cardiovascular events, renal function, and mineral metabolism.
Results:
VCs were observed in 50 patients (42%) before renal transplantation. Patients with VCs were older, but no statistical differences were found in the pre-transplant study between sex, diabetes, body mass index, and cardiovascular events. We found a major patient survival (limited to first 2 years after transplantation), graft survival, and death-censored graft survival in those without VCs (P = .037, P = .015, and P = .023, respectively). In line with results, a higher incidence of major cardiovascular events (MACE) and cardiovascular death was observed in the group with preexisting calcification (P = .016/P = .019). In the multivariable analysis, VCs were not an independent predictor for graft loss, death-censored graft loss, or major cardiovascular events.
Conclusions:
Simple evaluation of VCs with the use of the KI at the time of transplantation relates with graft and patient survival and with MACE after renal transplantation.
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