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. 2020 Sep 7;9(9):2893.
doi: 10.3390/jcm9092893.

Aorto-Iliac Artery Calcification Prior to Kidney Transplantation

Stan Benjamens  1   2 , Elsaline Rijkse  3 , Charlotte A Te Velde-Keyzer  4 , Stefan P Berger  4 , Cyril Moers  1 , Martin H de Borst  4 , Derya Yakar  2 , Riemer H J A Slart  2   5 , Frank J M F Dor  6   7 , Robert C Minnee  3 , Robert A Pol  1
Affiliations

Aorto-Iliac Artery Calcification Prior to Kidney Transplantation

Stan Benjamens et al. J Clin Med. .

Abstract

As vascular calcification is common in kidney transplant candidates, aorto-iliac vessel imaging is performed for surgical planning. The aim of the present study was to investigate whether a novel non-contrast enhanced computed tomography-based quantification technique for aorto-iliac calcification can be used for cardiovascular risk stratification prior to kidney transplantation. In this dual-center cohort study, we measured the aorto-iliac calcium score (CaScore) of 547 patients within three years prior to transplantation (2005-2018). During a median (interquartile range) follow-up of 3.1 (1.4, 5.2) years after transplantation, 80 (14.7%) patients died, of which 32 (40.0%) died due to cardiovascular causes, and 84 (15.5%) patients had a cardiovascular event. Kaplan-Meier survival curves showed significant differences between the CaScore tertiles for cumulative overall-survival (Log-rank test p < 0.0001), cardiovascular survival (p < 0.0001), and cardiovascular event-free survival (p < 0.001). In multivariable Cox regression, the aorto-iliac CaScore was associated with all-cause mortality (hazard ratio 1.53, 95%CI 1.14-2.06, p = 0.005), cardiovascular mortality (2.04, 1.20-3.45, p = 0.008), and cardiovascular events (1.35, 1.01-1.80, p = 0.042). These independent associations of the aorto-iliac CaScore with the outcome measures can improve the identification of patients at risk for (cardiovascular) death and those who could potentially benefit from stringent cardiovascular monitoring to improve their prognosis after transplantation.

Keywords: aorta; cardiovascular diseases; iliac artery; kidney transplantation; vascular calcification.

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Conflict of interest statement

The authors declare no conflict of interest. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Graphical image of the kidney transplant anatomy and the aorto-iliac calcium score (CaScore) assessment performed in three vascular segments, being (I) the abdominal aorta inferior of the renal arteries, (II) the common iliac artery, and (III) the external iliac artery on the side of the subsequent transplant.
Figure 2
Figure 2
Kaplan-Meier curve for cumulative overall survival for the low aorto-iliac calcium score (CaScore tertile), the medium CaScore tertile, and the high CaScore tertile. The overall survival at the median follow-up time was 94.9% (95% CI 91.5–98.5) in the low, 90.5% (95% CI 85.4–95.9) in the medium, and 71.0% (95% CI 62.7–80.3) in the high CaScore tertile.
Figure 3
Figure 3
Forest plot of hazard ratios for the univariable subgroup analysis and p-values of interaction analysis for aorto-iliac calcium score (CaScore) (continuous) and all-cause mortality.
Figure 4
Figure 4
Kaplan-Meier curve for (A) cardiovascular survival and (B) cardiovascular event-free survival for the low aorto-iliac CaScore tertile, the medium CaScore tertile, and the high CaScore tertile. The cardiovascular survival at the median follow-up time was 98.5% (95% CI 96.4–100.0) in the low, 96.3% (95% CI 92.8–99.9) in the medium, and 86.4% (95% CI 79.5–94.0) in the high CaScore tertile. The cardiovascular event-free survival at the median follow-up time was 89.3% (95% CI 84.6–94.4) in the low, 81.0% (95% CI 74.2–88.5) in the medium, and 75.2% (95% CI 67.0–85.5) in the high CaScore tertile.
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