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Alvarez-Perdomo LC, Cataño-Bedoya JU, Plaza-Tenorio M, Botero-Mora AM, Cardozo-Moreno IDP, Barrera-Lozano LM, Ramírez-Arbeláez JA, Ardila CM. Lower Extremity Peripheral Arterial Disease and Its Relationship with Adverse Outcomes in Kidney Transplant Recipients: A Retrospective Cohort Study. TRANSPLANTOLOGY 2023; 4:111-123. [DOI: 10.3390/transplantology4030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024] Open
Abstract
The purpose of the study was to characterize lower extremity peripheral arterial disease (LEPAD) in a series of kidney transplant patients and to assess the impact on adverse outcomes. A retrospective cohort study was conducted including kidney transplant recipient patients who underwent screening for LEPAD. The outcomes evaluated were classified as perioperative and post-transplant, including cardiovascular events, amputation, mortality, and loss of the graft. A total of 141 renal transplant patients screened for LEPAD were identified, with an average follow-up of 3 years. LEPAD occurred in 14.2% (20/141). No differences in cardiovascular risk factors were found between the groups, except for smoking (45% vs. 24%, p < 0.05). In the group with LEPAD, the most compromised anatomical segment was the infrapopliteus, with no iliac involvement found. The Cox proportional hazards model indicated that the variables age, gender, and weight were significant in patients with LEPAD. There were no differences between the groups in terms of graft loss and death. The infrapopliteal segment is the area of greatest stenosis in kidney transplant patients with LEPAD. Together with smoking, they can explain the presence of major amputations in kidney transplant patients; however, they had no impact on graft functionality or death.
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Affiliation(s)
| | - John Ubeimar Cataño-Bedoya
- Vascular Medicine Department, Faculty of Medicine, Universidad de Antioquia UdeA, Medellín 050010, Colombia
| | - Maribel Plaza-Tenorio
- Vascular Medicine Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia
| | - Ana María Botero-Mora
- Vascular Surgery Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia
| | | | - Luis Manuel Barrera-Lozano
- Vascular Medicine Department, Faculty of Medicine, Universidad de Antioquia UdeA, Medellín 050010, Colombia
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia
| | | | - Carlos M. Ardila
- Basic Studies Department, FdeO Universidad de Antioquia UdeA, Medellín 050010, Colombia
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2
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Babakry S, Rijkse E, Roodnat JI, Bijdevaate DC, IJzermans JNM, Minnee RC. Risk of post-transplant cardiovascular events in kidney transplant recipients with preexisting aortoiliac stenosis. Clin Transplant 2021; 36:e14515. [PMID: 34674329 PMCID: PMC9285727 DOI: 10.1111/ctr.14515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
Prediction of the risk of cardiovascular events (CVE's) is important to optimize outcomes after kidney transplantation. Aortoiliac stenosis is frequently observed during pre‐transplant screening. We hypothesized that these patients are at higher risk of post‐transplant CVE's due to the joint underlying atherosclerotic disease. Therefore, we aimed to assess whether aortoiliac stenosis was associated with post‐transplant CVE's. This retrospective, single‐center cohort study included adult kidney transplant recipients, transplanted between 2000 and 2016, with contrast‐enhanced imaging available. Aortoiliac stenosis was classified according to the Trans‐Atlantic Inter‐Society Consensus (TASC) II classification and was defined as significant in case of ≥50% lumen narrowing. The primary outcome was CVE‐free survival. Eighty‐nine of 367 patients had significant aortoiliac stenosis and were found to have worse CVE‐free survival (median CVE‐free survival: stenosis 4.5 years (95% confidence interval (CI) 2.8–6.2), controls 8.9 years (95% CI 6.8–11.0); log‐rank test P < .001). TASC II C and D lesions were independent risk factors for a post‐transplant CVE with a hazard ratio of 2.15 (95% CI 1.05–4.38) and 6.56 (95% CI 2.74–15.70), respectively. Thus, kidney transplant recipients with TASC II C and D aortoiliac stenosis require extensive cardiovascular risk management pre‐, peri,‐ and post‐transplantation.
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Affiliation(s)
- Shabnam Babakry
- Erasmus MC Transplant Institute, Division HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Elsaline Rijkse
- Erasmus MC Transplant Institute, Division HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Joke I Roodnat
- Erasmus MC Transplant Institute, Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diederik C Bijdevaate
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Erasmus MC Transplant Institute, Division HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Robert C Minnee
- Erasmus MC Transplant Institute, Division HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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3
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Werlin EC, Braun HJ, Walker JP, Freise JE, Amara D, Liu IH, Mello A, Tavakol M, Stock PG, Hiramoto JS. Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation. Front Med (Lausanne) 2021; 8:606835. [PMID: 33796543 PMCID: PMC8007790 DOI: 10.3389/fmed.2021.606835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Non-contrast computed tomography scans of the abdomen and pelvis (CTAP) are often obtained prior to renal transplant to evaluate the iliac arteries and help guide surgical implantation. The purpose of this study was to describe the association of iliac calcification scores with operative and clinical outcomes using a simplified scoring system. A retrospective review of 204 patients who underwent renal transplant from 1/2013 to 11/2014 and who had a CTAP within 3 years prior to transplant was performed. Data were collected from the electronic medical record. Common iliac artery (CIA) and external iliac artery (EIA) calcification on CTAP were assessed using a simple scoring system. Descriptive statistics, logistic regression, and survival analyses were performed. A total of 204 patients were included in the analysis. The mean age was 57.4 ± 11.2 years and 134/204 (66%) were men. Nineteen patients (9%) had a history of peripheral artery disease (PAD), 78 (38%) had coronary artery disease, and 22 (11%) had a previous cerebrovascular accident (CVA). Patients with severe right EIA plaque morphology were significantly more likely to require arterial reconstruction compared to those without severe plaque (3/14[21%] 4/153 [3%], p = 0.03). Eleven patients (5%) had one or more amputations (toe, foot, or transtibial) following transplant. In UV logistic regression, severe EIA plaque morphology (OR 8.1, CI 2.2–29.6, p = 0.002) and PAD (OR 10.7, CI 2.8–39.9, p = 0.0004) were associated with increased odds of amputation. In the MV model containing both variables, EIA plaque morphology (OR 4.4, CI 0.99–18.3, p = 0.04) and PAD (OR 6.3, CI 1.4–26.4, p = 0.01) remained independently associated with increased odds of amputation. Over a median follow up of 3.3 years (IQR 2.9–3.6), 21 patients (10%) had post-operative major adverse cardiac events (MACE, defined as myocardial infarction, coronary intervention, or CVA), and 23 patients died (11%). In unadjusted Kaplan Meier analysis, CIA plaque (p = 0.00081) and >75% CIA length calcification (p = 0.0015) were significantly associated with MACE. Plaque burden in the EIA is associated with increased need for intra-operative arterial reconstruction and post-operative lower extremity amputations, while CIA plaque is associated with post-operative MACE. Assessment of CIA and EIA calcification scores on pre-transplant CT scans in high risk patients may guide operative strategy and perioperative management to improve clinical outcomes.
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Affiliation(s)
- Evan C Werlin
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Hillary J Braun
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Joy P Walker
- Division of Cardiothoracic and Vascular Surgery, Ohio Health Hospital System, Columbus, OH, United States
| | - Jonathan E Freise
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Dominic Amara
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Iris H Liu
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Anna Mello
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Mehdi Tavakol
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Peter G Stock
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jade S Hiramoto
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
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Sorrells WS, Mao SA, Taner T, Jadlowiec CC, Farres H, Davila V, Money SR, Stone WM, Al-Khasawneh M, Da Rocha-Franco JADR, Oldenburg WA, Oderich GS, Taner CB, Hakaim AG, Erben Y. Endarterectomy for Iliac Occlusive Disease during Kidney Transplantation: A Multicenter Experience. Int J Angiol 2020; 30:91-97. [PMID: 34054266 DOI: 10.1055/s-0040-1714752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Little is known about the surgical challenges and outcomes of kidney transplantation (KT) in the face of severe iliac occlusive disease (IOD). We aim to examine our institution's experience and outcomes compared with all KT patients. Retrospective review of our multi-institutional transplant database identified patients with IOD requiring vascular surgery involvement for iliac artery endarterectomy at time of KT from 2000 to 2018. Clinical data, imaging studies, and surgical outcomes of 22 consecutive patients were reviewed. Our primary end-point was allograft survival. Secondary end-points included mortality and perioperative complications. A total of 6,757 KT were performed at our three sites (Florida, Arizona, and Minnesota); there were 22 (0.32%) patients receiving a KT with concomitant IOD requiring iliac artery endarterectomy. Mean patient age was 61.45 ± 7 years. There were 13 (59.1%) male patients. The most common etiology of renal failure was diabetic nephropathy in 10 patients (45.5%) followed by a combination of hypertensive/diabetic nephropathy in five patients (22.7%), and hypertensive nephrosclerosis in three patients (13.6%). The majority ( n = 16, 72.7%) of patients received renal allografts from deceased donors and six (27.3%) were recipients from living donors. Mean time from dialysis to transplantation was 2.9 ± 2.9 years. Mean follow-up was 3.5 ± 2.5 years. Mean length of hospital stay was 6.3 ± 4.3 days (range: 3-18 days). Graft loss within 90 days occurred in two (9.1%) patients, one due to renal vein thrombosis and another due to acute tubular necrosis. Overall allograft survival was 90.1% at 1-year and 86.4% at 3-year follow-up. Overall mortality occurred in 6 (27.3%) patients. Perioperative complications (Clavien-Dindo Grade 2-4) occurred in 13 (59.1%) patients, including 10 (45.5%) with acute blood loss anemia requiring transfusion, 2 (9.1%) reoperations for hematoma evacuation, 1 (4.5%) ischemic colitis requiring total abdominal colectomy, and 1 (4.5%) renal vein thrombosis requiring nephrectomy. IOD patients selected for KT are not common and although challenging, they have similar outcomes to our standard KT patients. The 1- and 3-year allograft survivals were 90.1 and 86.4% versus 96.0 and 90.3% in the general KT patient population. With these excellent outcomes, we recommend expanding the criteria for KT to include patients with IOD with prior vascular surgery consultation to prevent progression of IOD or prevention of wait list removal in select patients who are otherwise good candidates for KT.
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Affiliation(s)
- William S Sorrells
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Shennen A Mao
- Division of Transplantation Surgery, Mayo Clinic, Jacksonville, Florida
| | - Timucin Taner
- Division of Transplantation Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Victor Davila
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Samuel R Money
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Arizona
| | - William M Stone
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Arizona
| | | | | | - Warner A Oldenburg
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - C Burcin Taner
- Division of Transplantation Surgery, Mayo Clinic, Jacksonville, Florida
| | - Albert G Hakaim
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
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Impact of Aortoiliac Stenosis on Graft and Patient Survival in Kidney Transplant Recipients Using the TASC II Classification. Transplantation 2020; 103:2164-2172. [PMID: 30801546 DOI: 10.1097/tp.0000000000002635] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with end-stage renal disease and aortoiliac stenosis are often considered ineligible for kidney transplantation, although kidney transplantation has been acknowledged as the best therapy for end-stage renal disease. The clinical outcomes of kidney transplantation in patients with aortoiliac stenosis are not well-studied. This study aimed to assess the impact of aortoiliac stenosis on graft and patient survival. METHODS This retrospective, single-center study included kidney transplant recipients transplanted between January 1, 2000, and December 31, 2016, who received contrast-enhanced imaging. Patients with aortoiliac stenosis were classified using the Trans-Atlantic Inter-Society Consensus (TASC) II classification and categorized as having TASC II A/B lesions or having TASC II C/D lesions. Patients without aortoiliac stenosis were functioning as controls. RESULTS A total number of 374 patients was included in this study (n = 88 with TASC II lesions, n = 286 as controls). Death-censored graft survival was similar to the controls. Patient and uncensored graft survival was decreased in patients with TASC II C/D lesions (log-rank test P < 0.001). Patients with TASC II C/D lesions had a higher risk of 90-day mortality (hazard ratio, 3.96; 95% confidence interval, 1.12-14.04). In multivariable analysis, having a TASC II C/D lesion was an independent risk factor for mortality (hazard ratio, 3.25; 95% confidence interval, 1.87-5.67; P < 0.001). Having any TASC II lesion was not a risk factor for graft loss (overall P = 0.282). CONCLUSIONS Kidney transplantation in patients with TASC II A/B is feasible and safe without increased risk of perioperative mortality. TASC II C/D decreases patient survival. Death-censored graft survival is unaffected.
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6
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Recipient Comorbidity and Survival Outcomes After Kidney Transplantation: A UK-wide Prospective Cohort Study. Transplantation 2020; 104:1246-1255. [DOI: 10.1097/tp.0000000000002931] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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7
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Nelson AJ, Raggi P, Wolf M, Gold AM, Chertow GM, Roe MT. Targeting Vascular Calcification in Chronic Kidney Disease. JACC Basic Transl Sci 2020; 5:398-412. [PMID: 32368697 PMCID: PMC7188874 DOI: 10.1016/j.jacbts.2020.02.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 12/22/2022]
Abstract
Cardiovascular (CV) disease remains an important cause of morbidity and mortality for patients with chronic kidney disease (CKD). Although clustering of traditional risk factors with CKD is well recognized, kidney-specific mechanisms are believed to drive the disproportionate burden of CV disease. One perturbation that is frequently observed at high rates in patients with CKD is vascular calcification, which may be a central mediator for an array of CV sequelae. This review summarizes the pathophysiological bases of intimal and medial vascular calcification in CKD, current strategies for diagnosis and management, and posits vascular calcification as a risk marker and therapeutic target.
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Key Words
- CAC, coronary artery calcification
- CI, confidence interval
- CKD, chronic kidney disease
- CT, computed tomography
- CV, cardiovascular
- CVD, cardiovascular disease
- ESKD, end-stage kidney disease
- FGF, fibroblast growth factor
- HR, hazard ratio
- LDL-C, low-density lipoprotein cholesterol
- MGP, matrix Gla protein
- PTH, parathyroid hormone
- VSMC, vascular smooth muscle cell
- chronic kidney disease
- dialysis
- eGFR, estimated glomerular filtration rate
- medial calcification
- vascular calcification
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Affiliation(s)
- Adam J. Nelson
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
| | - Paolo Raggi
- Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Alexander M. Gold
- Research and Development, Sanifit Therapeutics, San Diego, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Glenn M. Chertow
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthew T. Roe
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
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8
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Rijkse E, van Dam JL, Roodnat JI, Kimenai HJAN, IJzermans JNM, Minnee RC. The prognosis of kidney transplant recipients with aorto-iliac calcification: a systematic review and meta-analysis. Transpl Int 2020; 33:483-496. [PMID: 32034811 PMCID: PMC9328363 DOI: 10.1111/tri.13592] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/04/2019] [Accepted: 02/05/2020] [Indexed: 12/22/2022]
Abstract
The prognosis of kidney transplant recipients (KTR) with vascular calcification (VC) in the aorto-iliac arteries is unclear. We performed a systematic review and meta-analysis to investigate their survival outcomes. Studies from January 1st, 2000 until March 5th, 2019 were included. Outcomes for meta-analysis were patient survival, (death-censored) graft survival and delayed graft function (DGF). Twenty-one studies were identified, eight provided data for meta-analysis. KTR with VC had a significantly increased mortality risk [1-year: risk ratio (RR) 2.19 (1.39-3.44), 5-year: RR 2.28 (1.86-2.79)]. The risk of 1-year graft loss was three times higher in recipients with VC [RR 3.15 (1.30-7.64)]. The risk of graft loss censored for death [1-year: RR 2.26 (0.58-2.73), 3-year: RR 2.19 (0.49-9.82)] and the risk of DGF (RR 1.24, 95% CI 0.98-1.58) were not statistically different. The quality of the evidence was rated as very low. To conclude, the presence of VC was associated with an increased mortality risk and risk of graft loss. In this small sample size, no statistical significant association between VC and DGF or risk of death-censored graft loss could be demonstrated. For interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.
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Affiliation(s)
- Elsaline Rijkse
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jacob L van Dam
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Joke I Roodnat
- Division of Nephrology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hendrikus J A N Kimenai
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert C Minnee
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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9
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Marcuzzi A, Wang S, Tyrrell PN, Ravichandran P, Marcuzzi D, Prabhudesai V, Stewart R. Distribution of Iliac Artery Calcification on Unenhanced Computed Tomography Scans Performed on Potential Recipients Prior to Renal Transplantation. Can Assoc Radiol J 2020; 72:438-443. [PMID: 32067485 DOI: 10.1177/0846537119899535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate whether a significant difference exists between the calcification of the common iliac arteries (CIAs) and the external iliac arteries (EIAs) and test for associations between clinical factors and the distribution of calcification. METHODS A retrospective review of renal transplant candidates who underwent a routine preoperative unenhanced computed tomography yielded 214 patients. Agatston scores for the patients' left CIA, left EIA, right CIA, and right EIA were assigned. A retrospective search of patient records screened for 5 clinical factors (diabetes, hypertension, coronary artery disease [CAD], smoking, and dialysis). Data were assessed using a 2-sided t test, odds ratio, and a multivariate linear regression calculated through generalized estimating equation (GEE). RESULTS The log-transformed Agatston scores in the CIA were found to be significantly greater than that in the EIA (t = 9.57, P < .0001), with a mean difference of 1.5078 (95% confidence interval: 1.1962-1.8194), indicating relative EIA sparing. There were no significant differences in calcification between the right and left sides. Generalized estimating equation found that CAD and smoking demonstrated independent positive associations with EIA sparing (GEE = 2.6464 [P = .0197] and 1.9092 [P = .0470], respectively). Age was also significantly associated and indicated that EIA sparing remained relatively constant throughout patients' lives (GEE = 1.0711 [P < .0001]). CONCLUSION This study has demonstrated statistically significant EIA sparing in end-stage renal disease patients and identified CAD and smoking as associated factors. This phenomenon warrants further investigation into its biological mechanisms and the impact of EIA sparing on outcomes following transplants.
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Affiliation(s)
| | - Stella Wang
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Pascal N Tyrrell
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
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10
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Franquet Q, Terrier N, Pirvu A, Rambeaud JJ, Long JA, Janbon B, Tetaz R, Malvezzi P, Jouve T, Descotes JL, Fiard G. Aortic bypass surgery for asymptomatic patients awaiting a kidney transplant: A word of caution. Clin Transplant 2018; 32:e13218. [DOI: 10.1111/ctr.13218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Quentin Franquet
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Nicolas Terrier
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Augustin Pirvu
- Department of Vascular Surgery; Grenoble University Hospital; Grenoble France
| | - Jean-Jacques Rambeaud
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Jean-Alexandre Long
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
- TIMC-IMAG Laboratory; CNRS; UMR 5525; Grenoble France
| | - Benedicte Janbon
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Rachel Tetaz
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Paolo Malvezzi
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Thomas Jouve
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Jean-Luc Descotes
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
- TIMC-IMAG Laboratory; CNRS; UMR 5525; Grenoble France
| | - Gaelle Fiard
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
- TIMC-IMAG Laboratory; CNRS; UMR 5525; Grenoble France
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11
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Chavent B, Maillard N, Boutet C, Albertini JN, Duprey A, Favre JP. Prognostic Value of Aortoiliac Calcification Score in Kidney Transplantation Recipients. Ann Vasc Surg 2017; 44:245-252. [PMID: 28479451 DOI: 10.1016/j.avsg.2017.03.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/26/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Kidney recipients are increasingly older with arterial disease and extended arterial calcifications. In a kidney transplantation population, the prognosis value of aortic and iliac calcifications remains poorly explored. We aimed to assess the impact of pretransplantation aortoiliac vascular calcifications on patients, grafts survival, and cardiovascular events. METHODS This retrospective study included kidney transplantation patients from 2006 to 2012 for whom we had available presurgery abdominal computed tomography results (n = 100). We designed a score to quantify aortoiliac calcifications. Primary end points were patient and graft survival. Secondary end points were renal function and cardiovascular morbidity. Predictive performances of calcification score were assessed using area under receiver-operating characteristic curves. Patients were classified in quartiles depending on global calcium score value. RESULTS The cumulated rate of death and graft loss was 13% with no significant differences for survival between quartiles. No significant difference was observed in renal function (P = 0.4). Seventeen cardiovascular events were registered with a significant correlation between calcium score elevation and need of cardiovascular surgery during the follow-up (P = 0.01). Global calcium score had a predictive value of 74.5% (95% confidence interval 0.62-0.87) with 71% sensitivity and 73% specificity. CONCLUSIONS Aortoiliac calcifications do not decrease patient and graft survival. High calcium score predict cardiovascular events and procedures during the follow-up.
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Affiliation(s)
- Bertrand Chavent
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Nicolas Maillard
- Department of Nephrology and Kidney Transplantation, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Boutet
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Noël Albertini
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Ambroise Duprey
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Pierre Favre
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
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12
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Kahn J, Ram LM, Eberhard K, Groselj-Strele A, Obermayer-Pietsch B, Müller H. Calcification score evaluation in patients listed for renal transplantation. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Judith Kahn
- Division of Transplantation Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Leona Marleen Ram
- Division of Transplantation Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Katharina Eberhard
- Core Facility Computational Bioanalytics; Center for Medical Research; Medical University of Graz; Graz Austria
| | - Andrea Groselj-Strele
- Core Facility Computational Bioanalytics; Center for Medical Research; Medical University of Graz; Graz Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Helmut Müller
- Division of Transplantation Surgery; Department of Surgery; Medical University of Graz; Graz Austria
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13
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La transplantation rénale et ses défis. Prog Urol 2016; 26:1001-1044. [PMID: 27720627 DOI: 10.1016/j.purol.2016.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 01/09/2023]
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14
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Monnot A, Lebras ML, Rouer M, Plissonnier D. Thoracic aorta to femoral artery bypass allows secondary kidney transplantation in case of major iliac artery disease. Ann Vasc Surg 2015; 29:1015.e1-3. [PMID: 25958119 DOI: 10.1016/j.avsg.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/22/2015] [Accepted: 02/22/2015] [Indexed: 11/25/2022]
Abstract
Iliac artery major calcifications can compromise kidney graft. First-performed prosthetic arterial bypass from the thoracic aorta to the femoral artery allows secondary kidney transplantation. Four patients were submitted to this procedure. No patient died during the postoperative period or the follow-up. The median time to receive a kidney graft after the arterial surgery was 24 months (4-52). The normalization of the sera creatinine level was 6.4 days (2-15). The median follow-up was 38 months (7-79). In our experience, using lateral side clamping of the descendant thoracic aorta during the proximal implantation of the arterial graft avoids bleeding and visceral abdominal ischemia. The secondary performed kidney graft is safe on a very available arterial conduit.
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Affiliation(s)
- Antoine Monnot
- Department of Vascular Surgery, Rouen University Hospital, Rouen, France
| | | | - Martin Rouer
- Department of Vascular Surgery, Rouen University Hospital, Rouen, France
| | - Didier Plissonnier
- Department of Vascular Surgery, Rouen University Hospital, Rouen, France.
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15
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Effects of Simultaneous Iliac Artery Angioplasty on Graft and Patient Survival After Living-Donor Kidney Transplantation. Transplantation 2014; 97:826-31. [DOI: 10.1097/01.tp.0000437566.54082.dc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Tozzi M, Franchin M, Soldini G, Ietto G, Chiappa C, Molteni B, Amico F, Carcano G, Dionigi R. Treatment of aortoiliac occlusive or dilatative disease concomitant with kidney transplantation: how and when? Int J Surg 2013; 11 Suppl 1:S115-9. [DOI: 10.1016/s1743-9191(13)60030-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Aitken E, Ramjug S, Buist L, Kingsmore D. The prognostic significance of iliac vessel calcification in renal transplantation. Transplant Proc 2012. [PMID: 23194999 DOI: 10.1016/j.transproceed.2012.06.058] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Peripheral vascular disease and major extremity amputation are common in patients with established renal failure and are associated with considerable morbidity. Several studies have shown high rates of amputation following simultaneous pancreas-kidney transplantation, but there is minimal literature on the incidence of amputation following renal transplantation. Furthermore, there is little evidence regarding the best method of predicting which patients might be at risk of developing peripheral vascular complications after transplantation. METHODS We undertook a 5 year follow-up on the cohort of patients who were on our renal transplant waiting list 5 years ago (January 2007). At this time, it was standard practice within our unit for all patients to have routine pelvic x-rays to assess for vascular calcification of the iliac vessels at the time of activation onto the transplant waiting list. Any patients with moderate/severe calcification on x-ray, which may complicate transplantation, were referred for computed tomography angiogram (CTA) of their aorto-iliac vessels. Mortality, transplantation outcomes, and amputation rates at 5 years were correlated with the severity of calcification on preoperative imaging. RESULTS One hundred eighty-seven patients were on the waiting list for renal transplantation in January 2007 (92 men; mean age, 58.3 +/- 6.2 years). Ninety-three patients received a transplant during the subsequent 5 years. By January 2012, 82 patients had a functioning transplant, 45 remained on the waiting list (5 suspended), 40 patients had died, and 20 were alive but no longer on the waiting list. Seventy-three (39.5%) had moderate or severe calcification on plain x-ray and went on to have CTA. Of these patients, 16 (21.9%) had extensive calcification affecting all the iliac vessels and were removed from the waiting list as a result. Preoperative imaging was useful in determining the side for surgery in a further 18 patients (24.3%). Twenty-two patients developed vascular complications. Nineteen (86.4%) had moderate-severe vascular calcification on imaging. Four of the patients with vascular complications (18.2%) underwent transplantation (2 had below knee amputation (BKA) prior to transplantation; 1 developed distal ischemia on the same side as the transplantation 2 years postoperatively; 1 had bilateral above knee amputation (AKA) approximately 2 years after transplantation). Eleven (50%) of the patients with vascular complications were dead at 5 years of follow-up. Mortality and amputation rates were higher in patients with moderate-severe calcification than minimal calcification (30.1% vs 16.6%; P = .02 and 10.9% vs 1.8%; P = .003, respectively). There was no difference in rates of delayed graft function (DGF), biopsy-proven acute rejection (BPAR), or creatinine at 1 year between patients who underwent transplantation with moderate-severe calcification and those without, however, intraoperative vascular complications (26.7% vs 3%; P < .001), graft loss (28.1% vs 3.4%; P = .01), and death with a functioning transplant (9.7% vs 1.6%; P = .04) rates were higher in patients with extensive calcification compared with those without. CONCLUSIONS Plain x-ray of the pelvis is a useful screening tool to identify those patients who may require further detailed vascular imaging prior to transplantation. Amputation rates following renal transplantation are low and peripheral vascular disease (PVD) in isolation should not preclude transplantation. Nevertheless, significant vascular calcification is predictive of mortality both with and without transplantation and graft loss in patients with a renal transplant.
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Affiliation(s)
- E Aitken
- Department of Renal Surgery, Western Infirmary, Glasgow, Scotland
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18
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Yuan XP, Gao W, Jiao WH, Wang CX. Kidney transplantation in diabetic recipients with iliac atherosclerosis: Arterial anastomosis with Nakayama's ring pin stapler after endarterectomy. Int J Urol 2011; 19:336-42. [DOI: 10.1111/j.1442-2042.2011.02934.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Aalten J, Dekker HM, van der Vliet JA, Hoitsma AJ. Does a plain X-ray of the pelvis predict arterial complications in renal transplantation? A prospective study. Nephrol Dial Transplant 2010; 26:2007-12. [DOI: 10.1093/ndt/gfq705] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Gill R, Shapiro R, Kayler LK. Management of peripheral vascular disease compromising renal allograft placement and function: review of the literature with an illustrative case. Clin Transplant 2010; 25:337-44. [DOI: 10.1111/j.1399-0012.2010.01351.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Analyse monocentrique et rétrospective des complications vasculaires de la transplantation rénale sur cinq années. Prog Urol 2010; 20:40-8. [DOI: 10.1016/j.purol.2009.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 07/28/2009] [Accepted: 09/14/2009] [Indexed: 11/22/2022]
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22
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Ploussard G, Mongiat-Artus P, Meria P, Tariel E, Gaudez F, De Kerviler E, Legendre C, Peraldi MN, Glotz D, Desgrandchamps F. What is the relevance of systematic aorto-femoral Doppler ultrasound in the preoperative assessment of patients awaiting first kidney transplantation: a monocentric prospective study. Nephrol Dial Transplant 2009; 25:270-4. [PMID: 19749144 DOI: 10.1093/ndt/gfp459] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The purpose of our study was to study the relevance of a systematic aorto-femoral colour Doppler ultrasound (DUS) in the evaluation of first renal transplant receivers. METHODS We prospectively studied 100 consecutive first renal transplant (RT) receivers. All patients had a preoperative physical examination with a careful vascular system evaluation including assessment of risk factors and colour DUS of aortic, iliac and femoral arteries. Renal transplantation was planned in the right iliac fossa with end-to-lateral vascular anastomoses. Clinical parameters, DUS results, operative and post-operative parameters at 3 months were compared according to the vascular assessment. RESULTS Among the 84 patients presenting with a normal preoperative physical arterial examination, 12 patients (14.3%) had an abnormal DUS, revealing atherosclerotic arteries, but no case of arterial stenosis. Among the 16 patients with abnormal physical arterial examination, 10 patients (62.5%) had abnormal DUS, including 4 cases of iliac stenosis. In 3 of the 16 patients (18.8%), DUS revealed right iliac artery stenosis requiring a modification in the surgical procedure. No additional vascular procedure was reported in the case of normal preoperative vascular examination. No technical problems during arterial anastomosis and no post-transplantation arterial complications were reported. In multivariate analysis, abnormal physical examination was the most significant risk factor of atherosclerotic infiltration in DUS. CONCLUSION The abnormality of arterial physical examination is the best clinical predictor of abnormal DUS in preoperative assessment of renal transplant receivers. However, the low sensitivity and positive predictive value of the physical examination do not support the conclusion that DUS can be avoided in patients with normal arterial physical examination. Nevertheless, in the case of arterial physical abnormality, 'for case' DUS is critical and helps in the surgical strategy in approximately 20% of cases.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology and Paris 7 University, Saint Louis Hospital, Paris, France
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23
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Fechner G, von Pezold C, Hauser S, Gerhardt T, Klehr HU, Müller SC. Impairment of long-term graft function after kidney transplantation by intraoperative vascular complications. Int Urol Nephrol 2008; 40:869-73. [PMID: 18459062 DOI: 10.1007/s11255-008-9387-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 04/03/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Surgical complications in kidney transplantation often demand reoperation and therefore may severely affect graft survival. Major complications can be divided into ureteral and vascular related. Reoperation for ureteral complications is supposed to worsen graft survival, but vascular complications or anastomosis technique has not been evaluated for this issue. PATIENTS AND METHODS Between 1994 and 2004 260 patients underwent kidney transplantation. All ureterovesical junctions were performed in extravesical technique with ureteral stenting in 132/260 (50.7%) patients. Arterial end-to-side anastomosis was performed routinely except for 13/260 (5%) with end-to-end anastomosis. Mean follow-up was 43 months (0-121) including serum creatinine and ultrasound inter alia. RESULTS Graft failure rate was 8.1% 12 months and 12.7% 60 months postoperatively. Of the patients, 29/260 (11.5%) underwent reoperation within 30 days after transplantation (stenosis or leakage of the ureterovesical junction: n = 8; vascular complications: n = 10; thrombectomy for graft vein thrombosis: n = 1; evacuation of hematoma: n = 6; nephrectomy for complete graft ischemia: n = 4). Reoperation for vascular-related complications significantly enhances the risk of graft failure (P < 0.05, Cox proportional hazard) compared to urological complications. Arterial end-to-end anastomosis was also found to have a negative impact on graft survival. No correlation between routine ureteral stenting and ureteral stenosis or leakage was found. CONCLUSION Our data emphasize the importance of vascular complications compared to ureteral ones in kidney transplantation. Resolving 'non-urological' problems successfully, kidney transplantation is a safe procedure in urological hands.
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Affiliation(s)
- Guido Fechner
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
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Modi P. Pertinent issues in pretransplant recipient workup. Indian J Urol 2007; 23:278-85. [PMID: 19718331 PMCID: PMC2721607 DOI: 10.4103/0970-1591.33725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Renal transplantation is recognized as the treatment of choice in most patients with end-stage renal disease. The evaluation of the candidate for kidney transplantation has been the recent subject of clinical practice guidelines published by the European Renal Association- European Dialysis Transplant Association and the American Society of Transplantation. The purpose of this article is to review the current literature for urological evaluation and treatment of patients prior to renal transplantation. In India, urologists are involved in evaluating not only the genitourinary problems but also vascular access and, vascular anatomy and pathology especially related to major pelvic vessels. Hence, evaluation of the transplant recipient should include assessment of vascular access for hemodialysis, access for peritoneal dialysis, assessment of pelvic vessels to which renal allograft vessels need to be anastomosed and genitourinary system. In addition, review of the serological tests for infective viral diseases like hepatitis and human immunodeficiency viruses should always be done before starting clinical evaluation. A note of the evaluation performed by other specialists like nephrologist, cardiologist, endocrinologist, pulmonologist, anesthetist etc. should always be reviewed.
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Affiliation(s)
- Pranjal Modi
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad - 380 016, India
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25
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Ozçelik A, Treckmann J, Paul A, Witzke O, Sotiropoulos G, Nadalin S, Malago M, Broelsch CE. Results of Kidney Transplantation With Simultaneous Implantation of Vascular Graft. Transplant Proc 2007; 39:509-10. [PMID: 17362769 DOI: 10.1016/j.transproceed.2006.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Arteriosclerosis and calcification of iliac arteries are common in patients on dialysis. This study sought to evaluate the outcome after kidney transplantation and simultaneous implantation of vascular grafts. PATIENTS AND METHODS In a single center study we evaluated donor and recipient data among 443 kidney transplantations in adults performed between January 2002 and October 2006. In 11 recipients (2.5%) a vascular graft (Gore-Tex) was implanted due to severe arterioscleroses of the iliac vessels. RESULTS Reconstruction of the lower limb blood supply was performed with an ileofemoral Gore-Tex-Bypass in 9 of 11 patients, with an aortofemoral bypass in 1 patient, and with a femoroiliac crossover bypass in 1 patient. Overall, 8 of 11 patients (73%) had an uneventful postoperative course. Six of 11 patients had primary graft function. CONCLUSIONS This analysis demonstrated that vascular reconstruction during kidney transplantation has to be performed rarely but has a strong impact on further life and kidney function. In 8 of 11 patients, kidney function at 6 months was good. Severe arteriosclerosis is usually not a contraindication for kidney transplantation. However, training in vascular surgery seems to be important to achieve satisfying results. In this series, simultaneous implantation of vascular prosthetic grafts was safe since there were no infectious complications of the graft itself.
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Affiliation(s)
- A Ozçelik
- Clinic for General, Visceral, and Transplantation Surgery, University Hospital of Essen, Essen, Germany.
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