Key result
Severe aortoiliac stenosis (TASC II C/D lesions) was an independent risk factor for mortality in kidney transplant recipients (HR 3.25; 95% CI 1.87-5.67; P<0.001).
Why the study?
Patients with end-stage renal disease and aortoiliac stenosis are often considered ineligible for kidney transplantation, and clinical outcomes in this population are not well-studied.
Does aortoiliac stenosis impact graft and patient survival in kidney transplant recipients?
Cohort (n=374)
No
Does aortoiliac stenosis impact graft and patient survival in kidney transplant recipients?
Kidney transplantation is feasible and safe in patients with mild-to-moderate aortoiliac stenosis (TASC II A/B), but severe stenosis (TASC II C/D) significantly increases mortality risk.
Severe aortoiliac stenosis signals higher mortality risk in kidney transplant recipients; leaves open whether revascularization improves outcomes.
BACKGROUND: Patients with end-stage renal disease and aortoiliac stenosis are often considered ineligible for kidney transplantation, although kidney transplantation has been acknowledged as the best therapy for end-stage renal disease. The clinical outcomes of kidney transplantation in patients with aortoiliac stenosis are not well-studied. This study aimed to assess the impact of aortoiliac stenosis on graft and patient survival. METHODS: This retrospective, single-center study included kidney transplant recipients transplanted between January 1, 2000, and December 31, 2016, who received contrast-enhanced imaging. Patients with aortoiliac stenosis were classified using the Trans-Atlantic Inter-Society Consensus (TASC) II classification and categorized as having TASC II A/B lesions or having TASC II C/D lesions. Patients without aortoiliac stenosis were functioning as controls. RESULTS: A total number of 374 patients was included in this study (n = 88 with TASC II lesions, n = 286 as controls). Death-censored graft survival was similar to the controls. Patient and uncensored graft survival was decreased in patients with TASC II C/D lesions (log-rank test P < 0.001). Patients with TASC II C/D lesions had a higher risk of 90-day mortality (hazard ratio, 3.96; 95% confidence interval, 1.12-14.04). In multivariable analysis, having a TASC II C/D lesion was an independent risk factor for mortality (hazard ratio, 3.25; 95% confidence interval, 1.87-5.67; P < 0.001). Having any TASC II lesion was not a risk factor for graft loss (overall P = 0.282). CONCLUSIONS: Kidney transplantation in patients with TASC II A/B is feasible and safe without increased risk of perioperative mortality. TASC II C/D decreases patient survival. Death-censored graft survival is unaffected.
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Rijkse et al. (2019) conducted a cohort in End-stage renal disease requiring kidney transplantation (n=374). Aortoiliac stenosis (TASC II C/D lesions) vs. Patients without aortoiliac stenosis was evaluated on Mortality (HR 3.25, 95% CI 1.87-5.67, p=<0.001). Severe aortoiliac stenosis (TASC II C/D lesions) was an independent risk factor for mortality in kidney transplant recipients (HR 3.25; 95% CI 1.87-5.67; P<0.001).
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