The impact of aorto-iliac calcifications on patient and graft survival in renal transplant recipients using the TASCII classification

A.A. Rijkse, H.J.A.N. Kimenai, M.A. van der Zijden, J.I. Roodnat, S. Ten Raa, D.C. Bijdevaate, J.N.M. IJzermans, R.C. Minnee

Friday 16 march 2018

14:30 - 14:40h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 18: Clinical

Introduction

Kidney transplantation is the therapy of choice in patients with end-stage renal disease. Aorto-iliac calcifications are a relative contra-indication for renal transplantation, even though the influence on patient and graft survival remains poorly explored. Aorto-iliac calcifications can be classified using the Trans Atlantic Inter-Society Consensus (TASC) II classification, which is based on the presence and extent of aorto-iliac stenotic lesions. The aim of this study is to assess the impact of aorto-iliac calcifications on patient and graft survival using the TASC II classification.

Methods

This retrospective single-center study included all kidney transplant recipients from 2000-2016 who had imaging-proven pre-transplantation aorto-iliac stenotic lesions. Patients were classified according to the TASC II classification if aorto-iliac stenotic lesions were present. All patients transplanted between 2007-2011 without aorto-iliac stenotic lesions were used as a control group. Primary endpoints were patient and graft survival. Cox regression analysis was used to evaluate risk factors for mortality and graft loss.

Results

Aorto-iliac stenotic lesions were observed in 78 patients before kidney transplantation. Seven hundred seventy-three patients were included as a control group. Overall patient survival was decreased for every TASC II class (TASC II A: p=0.001; B: p=0.004, C: p<0.001, D: p<0.001). No significant difference was found for 90-day mortality (TASC II A p=0.165; B p=1.000; C p=1.000) and 1-year mortality (TASC II A p=0.143; B p=1.000; C p=1.000) in patients with TASC II A, B or C lesions. Patients with TASC II D lesions had significantly higher 90-day (p=0.006) and 1-year (p <0.001) mortality. Death-censored graft survival was not significantly decreased for TASC II A, B and C compared to the control group (TASC II A p=0.792; B p=0.950; C p=0.160). Multivariate Cox model showed that any TASC II lesion was not a predictor of overall mortality (hazard ratio (HR) 1.52 confidence interval (CI) 0.94-2.46 p=0.091) or graft loss (HR 1.72; CI 0.94-3.17; p=0.080).

Conclusion

Kidney transplantation is a safe procedure in patients with TASC II A, B and C lesions. Graft survival is unaffected by aorto-iliac stenotic lesions. Therefore, aorto-iliac calcifications should not be a contra-indication for kidney transplantation.