[Vascular assessment of the receptor before kidney transplantation]

To analyze the prevalence of vascular risk factors in patients with end-stage renal failure who are candidates to kidney transplantation, determine the efficacy of Doppler ultrasound and to develop a diagnostic vascular algorithm.

The iliac, femoral, popliteal and posterior tibial arteries of 200 potential kidney graft recipients were evaluated by Doppler US. Patients were assessed for the following risk factors: hypertension, smoking, cholesterol and triglyceride levels, and obesity. Seventy of theses patients subsequently received a kidney allograft. A biopsy of the iliac artery was performed at the level of the arteriotomy.

Hypertension (72%), smoking (47%), obesity, hypercholesterolemia and hyperlipidemia (7%) were the most prevalent risk factors. Atherosclerosis was histologically demonstrated in 19.2%: 80% were fibrous plaques. The atherosclerotic arteries showed peak systolic and diastolic flows significantly lower than those of normal arteries (p < 0.05). The resistance index was higher in the atherosclerotic arteries (p < 0.01). The number of cigarettes (R = -0.78) and cholesterol levels (R = -0.43) correlated inversely with the peak flows in the posterior tibial artery.

Vascular evaluation of kidney graft recipients is fundamental. Claudication, hypertension, age > 60 years, asymmetrical pulses and femorobrachial index < 0.7 are indications for performing ultrasound evaluation prior to kidney transplantation.