Aorto-Iliac Artery Calcification and Graft Outcomes in Kidney Transplant Recipients

Stan Benjamens*, Saleh Z Alghamdi, Elsaline Rijkse, Charlotte A Te Velde-Keyzer, Stefan P Berger, Cyril Moers, Martin H de Borst, Riemer H J A Slart, Frank J M F Dor, Robert C Minnee, Robert A Pol

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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While the association of vascular calcification with inferior patient outcomes in kidney transplant recipients is well-established, the association with graft outcomes has received less attention. With this dual-centre cohort study, we aimed to determine the clinical impact of recipient pre-transplant aorto-iliac calcification, measured on non-contrast enhanced computed tomography (CT)-imaging within three years prior to transplantation (2005-2018). We included 547 patients (61.4% male, age 60 (interquartile range 51-68) years), with a median follow-up of 3.1 (1.4-5.2) years after transplantation. The aorto-iliac calcification score (CaScore) was inversely associated with one-year estimated-glomerular filtration rate (eGFR) in univariate linear regression analysis (standard β -3.3 (95% CI -5.1 to -1.5, p < 0.0001), but not after adjustment for potential confounders, including donor and recipient age (p = 0.077). In multivariable Cox regression analyses, a high CaScore was associated with overall graft failure (p = 0.004) and death with a functioning graft (p = 0.002), but not with death-censored graft failure and graft function decline. This study demonstrated that pre-transplant aorto-iliac calcification is associated with one-year eGFR in univariate, but not in multivariable linear regression analyses. Moreover, this study underlines that transplantation in patients with a high CaScore does not result in earlier transplant function decline or worse death censored graft survival, although ongoing efforts for the prevention of death with a functioning graft remain essential.

Original languageEnglish
Article number325
Number of pages14
JournalJournal of Clinical Medicine
Issue number2
Early online date17-Jan-2021
Publication statusPublished - Feb-2021


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