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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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Spaggiari M, Okoye O, Almario J, Tulla K, Di Cocco P, Benedetti E, Tzvetanov I. Simultaneous recipient external iliac endarterectomy and renal transplant - a propensity score matched analysis. Transpl Int 2019; 33:321-329. [PMID: 31730258 DOI: 10.1111/tri.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/13/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022]
Abstract
Patients with end-stage renal disease and severe iliac atherosclerosis are frequently denied renal transplant due to technical challenges, and risk of potential steal syndrome in the allograft, or ipsilateral limb. Few studies have evaluated the safety and efficacy of performing an endarterectomy in this setting. A single-center retrospective review of renal transplant patients from 1/2013 to 12/2017 was performed. Patients requiring endarterectomy at the time of transplant were matched to a nonendarterectomized cohort in a 1:2 fashion using propensity score matching. Patients were followed for a minimum of 12 months. Simultaneous endarterectomy and renal transplant were performed in 23 patients and subsequently matched to 42 controls. Ankle-brachial index was lower in the endarterectomized group (P = 0.04). Delayed graft function (26.1% vs. 19%, P = 0.54), graft loss (8.7% vs. 7.1%, P = 0.53), 1-year mortality (8.7% vs. 4.8%, P = 0.53), and renal function at 12 months were comparable in both groups. There were no incidents of ipsilateral limb loss in the endarterectomized population. This is the first matched study investigating endarterectomy and renal transplant. Long-term follow-up of limb and graft function is indicated. Despite the small sample size, our findings suggest that a combined procedure can safely provide renal transplantation access to a previously underserved population.
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Affiliation(s)
- Mario Spaggiari
- Division of Transplantation, Department of General Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Obi Okoye
- Division of Transplantation, Department of General Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Jorge Almario
- Division of Transplantation, Department of General Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Kiara Tulla
- Division of Transplantation, Department of General Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Pierpaolo Di Cocco
- Division of Transplantation, Department of General Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Enrico Benedetti
- Division of Transplantation, Department of General Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ivo Tzvetanov
- Division of Transplantation, Department of General Surgery, University of Illinois at Chicago, Chicago, IL, USA
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