Iliac peripheral arterial disease before kidney transplantation: the influence of intervention

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M.A. van der Zijden, M. Laging, J. Kal-van Gestel, M.J. Poldervaart, H.J.A.N. Kimenai, S. ten Raa, J.I. Roodnat

Chair(s): dr. D.E. Braat & dr. N.C. van der Weerd

Thursday 9 march 2017

9:12 - 9:24h at Johan de Meesterzaal

Categories: Parallel - Klinisch

Parallel session: Parallelsessie XII – Klinisch 4 - Pretransplantatie en donatie

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Background:
Peripheral arterial disease may exclude kidney transplantation when vascular connectivity is hampered. Stenotic or calcified iliac vessels without symptoms are not an indication for vascular treatment. How important is peripheral artery disease for survival and what is the influence of intervention before transplantation?

Methods:
Our retrospective study included 1728 patients transplanted between 2000-2012. Peripheral vascular disease was scored as: stenosing or dilating disease, dissection, and vascular intervention in the iliac region. Separately microvascular disease (amputations in diabetes mellitus) and ≥3 transplantations were scored. Other variables included are: recipient age, PRAmax, transplant-year, number of HLAmismatches, donor type, donor age, CNI-use, and the RoCKeT score after extraction of peripheral arterial disease, which was used to correct for comorbidities. Multivariable Cox proportional hazards analyses were performed to test the independent influence of peripheral vascular disease variables, corrected for variables with a known significant influence.

Results:
There were 325 graft failures and 215 deaths in the period studied. There were missing values in 5 cases. In multivariable Cox analysis graft failure censored for death was significantly influenced by peripheral vascular disease (n=141, p=0.021, RR=1.59) and by the known variables but not by the adjusted RoCKeT score. In a separate multivariable analysis occlusive vascular disease did significantly influence outcome (n=91, p=0.007, RR=1.93), while dilating disease (n=55) did not influence outcome. Furthermore, untreated arterial disease significantly influenced outcome (n=77, p=0.013, RR=1.91), while treated disease (n=72) did not influence outcome. Patient death was significantly influenced by peripheral arterial disease (p=0.003, RR1.75) and the adjusted RoCKeT score (p<0.001).

Conclusion:
Graft survival is negatively influenced by the presence of  peripheral arterial occlusive disease, but not by the presence of dilating vascular disease. Patients untreated for arterial disease before transplantation have increased graft of graft failure  while treated patients do not have an increased risk.