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Ipsilateral Aorto-Iliac Calcification is Not Directly Associated With eGFR After Kidney Transplantation: A
Elsaline Rijkse1, Joke I Roodnat2, Sara J Baart3
1Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands.
Insights
Aorto-iliac calcification (AIC) does not directly impact kidney function after transplant. However, severe AIC is linked to a declining estimated glomerular filtration rate (eGFR) trajectory after 100 days.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Transplantation
Background:
- Aorto-iliac calcification (AIC) is a known risk factor for cardiovascular events and mortality post-transplant.
- The impact of AIC on kidney graft function, specifically estimated glomerular filtration rate (eGFR), is not well understood.
Purpose of the Study:
- To prospectively assess the association between AIC and eGFR in the first year following kidney transplantation.
- To investigate whether AIC influences the trajectory of graft function over time.
Main Methods:
- A prospective cohort study included 140 patients aged ≥50 years or ≥30 years with vascular disease risk factors.
- Aorto-iliac calcification (AIC) was quantified using a modified Agatston score from non-contrast-enhanced CT scans.
- The association between AIC and eGFR was analyzed using a linear mixed model, with adjustments for predefined variables.
Main Results:
- No direct association was found between the severity of AIC and eGFR levels in the first year post-transplant.
- A significant interaction between follow-up time and ipsilateral AIC was observed (p = 0.014).
- Patients with higher AIC scores exhibited a lower eGFR trajectory starting around 100 days post-transplant.
Conclusions:
- Severe aorto-iliac calcification (AIC) is not directly associated with lower post-transplant estimated glomerular filtration rate (eGFR).
- AIC demonstrates a significant interaction with time, indicating a declining eGFR trajectory in patients with more severe calcification after the initial 100 days post-transplant.
- This suggests a potential long-term impact of AIC on kidney graft function beyond the immediate post-transplant period.
Abstract:
Aorto-iliac calcification (AIC) is a well-studied risk factor for post-transplant cardiovascular events and mortality. Its effect on graft function remains unknown. The primary aim of this prospective cohort study was to assess the association between AIC and estimated glomerular filtration rate (eGFR) in the first year post-transplant. Eligibility criteria were: ≥50 years of age or ≥30 years with at least one risk factor for vascular disease. A non-contrast-enhanced CT-scan was performed with quantification of AIC using the modified Agatston score. The association between AIC and eGFR was investigated with a linear mixed model adjusted for predefined variables. One-hundred-and-forty patients were included with a median of 31 (interquartile range 26-39) eGFR measurements per patient. No direct association between AIC and eGFR was found. We observed a significant interaction between follow-up time and ipsilateral AIC, indicating that patients with higher AIC scores had lower eGFR trajectory over time starting 100 days after transplant (p = 0.014). To conclude, severe AIC is not directly associated with lower post-transplant eGFR. The significant interaction indicates that patients with more severe AIC have a lower eGFR trajectory after 100 days in the first year post-transplant.
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