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Impact of Abdominal Aortic Calcification Among Liver Transplantation Recipients
Yuki Imaoka1, Masahiro Ohira1,2, Ryosuke Nakano1
1Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Insights
High abdominal aortic calcification (AAC) is linked to poorer survival after liver transplantation (LT). This finding suggests AAC is an independent risk factor for liver transplant outcomes.
Area of Science:
- Cardiovascular Medicine
- Transplantation Surgery
- Nephrology
Background:
- Abdominal aortic calcification (AAC) is a known risk factor for cardiovascular and renal diseases.
- The prognostic value of incidental AAC in liver transplantation (LT) recipients remains unclear.
- Evaluating AAC's impact on post-LT survival and complications is crucial.
Purpose of the Study:
- To investigate the association between abdominal aortic calcification (AAC) levels and outcomes in liver transplantation (LT) patients.
- To determine if AAC is an independent predictor of post-transplant survival.
Main Methods:
- Retrospective analysis of 156 LT patients from January 2007 to December 2014.
- Patients were categorized into low (<100 mm³ Agatston score) and high (≥100 mm³ Agatston score) AAC groups.
- Propensity matching and multivariate analysis were used to assess prognostic factors.
Main Results:
- Liver transplant recipients with high AAC had significantly shorter survival times compared to those with low AAC (median 3.0 vs. 4.5 years, P < 0.01) even after propensity matching.
- High AAC level (HR 2.2) and older donor age (HR 2.2) were identified as independent negative prognostic factors for overall survival.
- Incidental AAC findings may have significant clinical implications for LT outcomes.
Conclusions:
- Elevated abdominal aortic calcification is an independent unfavorable prognostic factor in liver transplantation.
- Pre-transplant assessment of AAC may aid in risk stratification for LT candidates.
- Further research is warranted to explore the mechanisms linking AAC to LT outcomes.
Abstract:
Abdominal aortic calcification (AAC) is known as a risk factor of coronary artery disease, stroke, hyperphosphatemia, chronic inflammation, diabetes, and decreased estimated glomerular filtration rate. However, the clinical implications of incidental AAC findings in liver transplantation (LT) have not been evaluated in terms of posttransplantation survival and complications. Therefore, we analyzed the relationships between the AAC level and the outcomes following LT. A total of 156 consecutive patients who underwent LT between January 2007 and December 2014 were divided into 2 groups according to their AAC level (<100 mm3 or ≥100 mm3 ), as calculated using the Agatston method. Even after propensity matching, the survival time was significantly longer in the low-AAC group compared with that in the high-AAC group (median survival time, 4.5 versus 3.0 years; P < 0.01). A multivariate analysis identified high AAC level (hazard ratio, 2.2) and old donor age (hazard ratio, 2.2) as prognostic factors for overall survival. In conclusion, high AAC is an independent unfavorable prognostic factor in LT.
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