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Abdominal Arterial Calcification as an Imaging Biomarker of Mortality in Kidney Transplant Waitlist Patients
Wassim Toomah1, Roaa Ghanem1, Amro Idilbi1
1Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA.
Insights
Abdominal arterial calcification (AAC) is a significant predictor of mortality in kidney transplant candidates. Higher AAC scores indicate increased risk, aiding in better patient stratification for those awaiting kidney transplants.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Kidney transplant demand outstrips supply, increasing mortality risk for end-stage kidney disease patients.
- Cardiovascular disease is a leading cause of death in kidney transplant candidates, often linked to large artery calcification.
Purpose of the Study:
- To investigate the association between abdominal arterial calcification (AAC) and survival rates in individuals awaiting kidney transplantation.
Main Methods:
- A modified Agatston scoring method was used to quantify AAC from abdominal CT scans of 4184 adult kidney transplant candidates (2005-2023).
- Patients were categorized into those who died while awaiting transplant (DWL) and those who survived (SWL).
Main Results:
- 10.7% of candidates died while on the waiting list; DWL patients had significantly higher AAC scores.
- Each 1000-point increase in total AAC score correlated with a 5.1% rise in mortality risk (HR 1.051, p < 0.001).
- An AAC cutoff of >1769 was linked to reduced 5-year survival (45.4% vs. 77.4%, p < 0.001).
Conclusions:
- Non-contrast abdominal CT-based AAC scoring serves as a noninvasive biomarker for mortality risk in kidney transplant waitlist patients.
- AAC scoring can potentially improve risk stratification and personalize care for transplant candidates.
Aim:
The supply of donor kidneys (living and deceased) has fallen far behind the need, while the number of patients with end stage kidney disease continues to rise, increasing their risk of cardiovascular mortality. Kidney transplant candidates frequently exhibit large artery calcification, a major contributor to cardiovascular death. This study aimed to evaluate the relationship between abdominal arterial calcification (AAC) and survival in patients awaiting kidney transplant.
Methods:
We modified the coronary calcium scoring method (Modified Agatston Method) and applied it to quantify AAC. This retrospective study included all adult patients (N = 4184) listed for kidney transplant from 2005 to 2023 who had undergone abdominal computed tomography (CT) scans. Patients were categorised into two groups: those who died while on the waiting list (DWL) and those who survived (SWL).
Results:
Among 4184 candidates, 446 (10.7%) died while on the waiting list, and 3738 (89.3%) survived to transplant or study end. Patients in the DWL group had significantly higher AAC scores across all vascular sites. The median total AAC score was 3605.8 (IQR 780.1-9017.3) in the DWL group versus 940.1 (IQR 49.2-4915.0) in the SWL group. Each 1000-point increase in total AAC was associated with a 5.1% increase in mortality risk (HR 1.051; p < 0.001). An AAC cutoff of > 1769 correlated with reduced 5-year survival (45.4% vs. 77.4%, p < 0.001).
Conclusion:
AAC scoring on non-contrast abdominal CT represents a noninvasive biomarker of mortality in kidney transplant waitlist patients and may enhance risk stratification and personalised care.
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01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
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