366 Peritoneal Dialysis as a Predictor of Pre-Transplant Medical Arterial Calcification in Waitlist Kidney Transplant Candidates: A Propensity Score Weighting Analysis

Introduction: Medial arterial calcification (MAC) detected in the breast by mammography (MG) is exclusively medial and associated with cardiovascular mortality in end-stage renal disease (ESRD). This association is unclear in renal transplant recipients (RTR). Hypothesis: By comparing groups of study population balanced by propensity score weighting method, MAC is associated with an increased risk of post-transplant mortality. Methods: Female RTR was divided into 2 groups per presence or absence of pre-transplant MAC examined from MG (MAC and non-MAC), and both groups was balanced with by PS weighting leading to a new study population. Association between MAC and post-transplant mortality of the new study population was examined by multi-variable logistic regression analysis. Results: Of 51 patients, mean age±SD was 57.08±10.47 years old. The majority were white (54.9%) followed by African American (35.3%) and others (9.8%). Incidence rate of mortality was 0.0307 person-years. Median time to follow-up was 3.95 years (range 0.22 to 6.37). Among 20 patients in MAC group, 5 patients died; whereas, only 1 out of 31 patients in non-MAC died (25% vs. 3.23%, p 0.029). Baseline characteristics of both groups were not equal. After using PS weights with generalized boosted modeling, new study population’s characteristics were balanced (Figure 1). MAC is associated with 5.97 times higer the odd of morality compared to non-MAC, but the association was not significant (OR 5.97; 95%CI 0.61, 58.77). After adjusted for age, race, causes of ESRD, dialysis modality, dialysis vintage, donor type, donor age, and type of immunosuppressive medications, the magnitude of the association was increased and becomes significant (OR 38.40; 95%CI 2.44, 604.54). Conclusions: Similar to ESRD, MAC remains associated with higher mortality in RTR and this association is confirmed by well-matched study population. Prevention of pre-transplant MAC should be pursued to mitigate poor post-transplant outcomes.

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To screen or not to screen? The development of a prediction model for aorto‐iliac stenosis in kidney transplant candidates

Transplant International ◽

10.1111/tri.14013 ◽

2021 ◽

Author(s):

Elsaline Rijkse ◽

Hongchao Qi ◽

Shabnam Babakry ◽

Diederik C. Bijdevaate ◽

Hendrikus J.A.N. Kimenai ◽

...

Keyword(s):

Prediction Model ◽

Kidney Transplant ◽

Transplant Candidates

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Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

Urologia Internationalis ◽

10.1159/000516678 ◽

2021 ◽

pp. 1-8

Author(s):

Dominik Promny ◽

Theresa Hauck ◽

Aijia Cai ◽

Andreas Arkudas ◽

Katharina Heller ◽

...

Keyword(s):

Wound Healing ◽

Kidney Transplantation ◽

Postoperative Complications ◽

Kidney Transplant ◽

Interdisciplinary Approach ◽

Wound Complications ◽

Obese Patients ◽

Patient Cohort ◽

Transplant Candidates ◽

Stage Renal Disease

Background: Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. Methods: A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. Results: The median body mass index was 35.2 kg/m2 (range 28.5–53.0 kg/m2) at first transplant-assessment versus 31.0 kg/m2 (range 28.0–34.4 kg/m2) at panniculectomy, and 31.6 kg/m2 (range 30.3–32.4 kg/m2) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. Conclusion: Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.

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Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02025-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ashwin Radhakrishnan ◽

Luke C. Pickup ◽

Anna M. Price ◽

Jonathan P. Law ◽

Kirsty C. McGee ◽

...

Keyword(s):

Confidence Interval ◽

Renal Disease ◽

Kidney Transplant ◽

End Stage Renal Disease ◽

Microvascular Dysfunction ◽

Left Ventricular ◽

Coronary Microvascular Dysfunction ◽

Transplant Candidates ◽

Stage Renal Disease ◽

End Stage

Abstract Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

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