Evaluation of the Effectiveness of Screening for Iliac Arterial Calcification in Kidney Transplant Candidates

BACKGROUND Peripheral vascular disease and iliac arterial calcification are prevalent in kidney transplant candidates and jeopardize graft outcomes. We report our experience with computed tomography (CT) screening for iliac arterial calcification. MATERIAL AND METHODS We retrospectively reviewed electronic medical records of 493 renal transplant candidates from protocol initiation in 2014. Non-contrast CT was performed or retrospectively reviewed if any of the following criteria were present: diabetes, ESRD >6 years, 25 pack-years of smoking or current smoker, diagnosis of peripheral vascular disease, parathyroidectomy, and coronary artery disease intervention. Differences in evaluation and transplant outcomes between groups were compared with chi-squared analysis. Multivariate logistic regression identified predictive criteria for presence of iliac arterial calcification. RESULTS Of 493 candidates evaluated, CTs were reviewed in 346 (70.2%). Iliac arterial calcification was identified in 119 screened candidates (34.4%). Of candidates with iliac arterial calcification identified on CT, 16 (13.4%) were excluded for CT findings, and 9 (7.6%) had their surgical management plan changed. Overall, 91 (76.5%) candidates with iliac arterial calcification on CT were approved, compared to 203 (89.4%) without calcification (P<0.001). The percentage of screened patients with iliac arterial calcification on CT increased with increasing age (P<0.0005). Age and diabetes mellitus were predictive of calcification. CONCLUSIONS Many kidney transplant candidates are at risk for iliac arterial calcification, although such calcification does not prevent transplantation for most candidates who have it. Algorithmic pre-operative screening has clinical value in determining transplant candidacy and potentially improving postoperative outcomes in patients requiring kidney transplantation.