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. 2023 Feb 25;408(1):105.
doi: 10.1007/s00423-023-02838-z.

Kidney transplantation following iliac revascularization in severe atherosclerosis: a comparative study

Anna E Cyrek  1 , Lena Flögel  2 , Arkadius Pacha  3 , Moritz Kaths  4 , Jürgen Treckmann  4 , Andreas Paul  4 , Maren Schulze  4
Affiliations

Kidney transplantation following iliac revascularization in severe atherosclerosis: a comparative study

Anna E Cyrek et al. Langenbecks Arch Surg. .

Abstract

Background: Kidney transplantation (KT) has become the standard of care for patients with end-stage renal disease. However, as atherosclerosis progresses with time on dialysis, it causes increasing difficulties in implanting the graft. This is a comparative study analyzing complications and graft survival of recipients with iliac revascularization before transplantation.

Methods: Between January 2006 and December 2015, 1691 kidney transplants were performed at our institution. We retrospectively analyzed eighteen patients with peripheral arterial disease (PAD) with the necessity of vascular revascularization before kidney transplantation to protect the inflow to the renal graft and to optimizing blood supply to the extremities. The primary endpoint included patient survival and graft survival. The secondary endpoints evaluate perioperative and early postoperative complication rates after kidney transplantation.

Results: All patients enrolled in this study underwent two consecutive surgical procedures. No patient reported limb loss, and there was no additional perioperative morbidity or mortality related to the vascular procedure. Primary endpoints such as graft survival without dialysis and overall patient survival show 1-month survival of 100%, 1-year survival of 94.1%, and 5-year survival of 84.70%, respectively. One graft failure occurred 8 months after transplantation due to acute rejection, and there were two deaths over follow-up period due to myocardial infarction.

Conclusions: Vascular repair before kidney transplantation is safe, and results are suggestive that it prolongs graft survival. These promising results should encourage other centers to address vascular repair before the transplantation to optimize blood supply to the extremity and the future graft. Although, the interpretation of our results must be cautiously because of the small and heterogeneous sample size, and the limitations of retrospective study design. Prospective trials with larger study populations are needed to confirm the results of this study and to identify significant differences.

Keywords: Graft survival; Iliac revascularization; Kidney transplantation; Outcome.

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Conflict of interest statement

The authors declare no competing interests.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The course of the postoperative mean creatinine values in mg/dL
Fig. 2
Fig. 2
Distribution of postoperative complications using the Clavien-Dindo classification
See this image and copyright information in PMC

References

    1. Collins AJ, Foley RN, Herzog C, et al. US Renal Data System 2012 Annual Data Report. Am J Kidney Dis. 2013;61(A7):e1–476. - PubMed
    1. Lacour B, Roullet J-B, Beyne R, Kreis H, Thevenin M, Drtieke T. Comparison of several atherogenicity indices by the analysis of serum lipoprotein composition in patients with chronic renal failure with or without hemodialysis, and in renal transplant patients. J Clin Chem Clin Biochem. 1985;23:805–810. - PubMed
    1. Linder A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med. 1974;290:697–701. doi: 10.1056/NEJM197403282901301. - DOI - PubMed
    1. Gallagher K, Ravin R, Schweiter E, et al. Outcome and timing of aortic surgery in renal transplant patients. Ann Vasc Surg. 2011;25:448. doi: 10.1016/j.avsg.2010.12.007. - DOI - PubMed
    1. Arinze NV, Gregory A, Francis JM, Farber A, et al. Unique aspects of peripheral artery disease in patients with chronic kidney disease. Vasc Med. 2019;24(3):251–260. doi: 10.1177/1358863X18824654. - DOI - PubMed