Reduction of Arterial Stiffness After Kidney Transplantation: A Systematic Review and Meta‐Analysis

Background End‐stage kidney disease is associated with increased arterial stiffness. Although correction of uremia by kidney transplantation ( KT x) could improve arterial stiffness, results from clinical studies are unclear partly due to small sample sizes. Method and Results We conducted a systematic review and meta‐analysis of before‐after design studies performed in adult KT x patients with available measures of arterial stiffness parameters (pulse wave velocity PWV , central pulse pressure PP, and augmentation index) before and at any time post‐ KT x. Mean difference of post‐ and pre‐ KT x values of different outcomes were estimated using a random effect model with 95% confidence interval. To deal with repetition of measurement within a study, only 1 period of measurement was considered per study by analysis. Twelve studies were included in meta‐analysis, where a significant decrease of overall PWV by 1.20 m/s (95% CI 0.67‐1.73, I 2 =72%), central PWV by 1.20 m/s (95% CI 0.16‐2.25, I 2 =83%), peripheral PWV by 1.17 m/s (95% CI 0.17‐2.17, I 2 =79%), and brachial‐ankle PWV by 1.21 m/s (95% CI 0.66‐1.75, I 2 =0%) was observed. Central PP (reported in 4 studies) decreased by 4.75 mm Hg (95% CI 0.78–10.28, I 2 =50%). Augmentation index (reported in 7 studies) decreased by 10.5% (95% CI 6.9‐14.1, I 2 =64%). A meta‐regression analysis showed that the timing of assessment post‐ KT x was the major source of the residual variance. Conclusions This meta‐analysis suggests a reduction of the overall arterial stiffness in patients with end‐stage kidney disease after KT x.