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Published on: May 31, 2016
Long-term Clinical Outcome of Aortic Arch Calcification in Kidney Transplant Recipients
1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea; Keimyung University Kidney Institute, Daegu, Korea.
Insights
Aortic arch calcification (AoAC) is a significant predictor of poor cardiovascular outcomes in kidney transplant recipients (KTRs). Regular chest radiography screening for AoAC can help reduce cardiovascular mortality in KTRs.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Cardiovascular disease is the leading cause of mortality in kidney transplant recipients (KTRs).
- Aortic arch calcification (AoAC) is a recognized risk factor for cardiovascular events in KTRs.
- This study investigates the long-term prognostic implications of AoAC in KTRs.
Purpose of the Study:
- To assess the long-term outcomes associated with aortic arch calcification (AoAC) in kidney transplant recipients (KTRs).
- To identify predictors of AoAC and all-cause mortality in KTRs.
Main Methods:
- Retrospective evaluation of AoAC in KTRs from 2000-2010 using chest radiography.
- Semi-quantitative estimation of AoAC via a calcification score.
- Analysis of associations between clinical/biochemical parameters and AoAC, and their impact on survival.
Main Results:
- Of 258 KTRs, 20.5% had AoAC at transplantation, with prevalence increasing over time.
- AoAC prevalence rose to 28.7% by 5 years post-transplant.
- 10-year patient survival was lower in the AoAC group (90.6%) compared to the non-AoAC group (95.7%).
- Age at transplantation, deceased-donor KT, and diabetes mellitus predicted all-cause mortality.
Conclusions:
- Aortic arch calcification (AoAC) is an independent predictor of adverse cardiovascular outcomes in KTRs.
- Age and dialysis duration are risk factors for developing AoAC.
- Chest radiography is a valuable tool for screening AoAC and mitigating cardiovascular mortality in KTRs.
Introduction:
Cardiovascular disease is the most common cause of death in kidney transplant recipients (KTRs). Aortic arch calcification (AoAC) is a major risk factor for cardiovascular disease in KTRs. This study aimed to evaluate the long-term outcomes of AoAC in KTRs.
Methods:
We retrospectively evaluated AoAC in KTRs between 2000 and 2010 using chest radiography. AoAC was semiquantitatively estimated by calculating calcification score. Associations between clinical and biochemical parameters were evaluated.
Results:
A total of 258 patients were enrolled; the mean age was 40.7 years, and 135 (52.3%) were males. Diabetes mellitus was present in 28 (10.9%), and deceased donor kidney transplantation (KT) had been performed in 95 (36.8%). Fifty-three (20.5%) patients had AoAC at the time of KT, with an AoAC score of 0.8 ± 2.0. The proportion of KTRs with AoAC gradually increased to 23.3%, 26.4%, and 28.7% at 1, 3, and 5 years, respectively, after KT. The AoAC score also gradually increased to 1.0 ± 2.3, 1.2 ± 2.8, and 1.6 ± 3.1, respectively, at 1, 3, and 5 years after KT. The 10-year graft survival rate was 83.2% in the AoAC group and 85.1% in the non-AoAC group. The 10-year patient survival rate was 90.6% in the AoAC group and 95.7% in the non-AoAC group. In multivariate analysis, age at KT, deceased-donor KT, and diabetes mellitus were independent predictors for all-cause mortality.
Conclusions:
AoAC is an independent predictor of poor cardiovascular outcome in KTRs. Age and dialysis duration were independent risk factors for AoAC. Age at KT, deceased-donor KT, and diabetes mellitus were independent predictors for all-cause mortality. Regular follow-up by chest radiography could be a simple and useful method to screen for AoAC and reduce cardiovascular mortality.
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