Risk factors of transplant renal artery stenosis in kidney transplant recipients

Background: Transplant Renal Artery Stenosis (TRAS) is a recognized vascular complication after kidney transplantation. The overall risk predictors of TRAS are poorly understood. Methods: Retrospective analysis of patients with suspected TRAS (Doppler ultrasound PSV > 200 cm/s) who underwent angiographic study in a single center between 2007 and 2014. All patients with stenosis > 50% were considered with TRAS. Stenosis restricted in the body of the artery was also analyzed in a subgroup. Results: 274 patients were submitted to a renal angiography and 166 confirmed TRAS. TRAS group featured an older population (46.3 ± 11.0 vs. 40.9 ±14.2 years; p = 0.001), more frequent hypertensive nephropathy (30.1% vs. 15.7%; p = 0.01), higher incidence of Delayed Graft Function (DGF) (52.0% vs. 25.6%; p < 0.001) and longer Cold Ischemia Time (CIT) (21.5 ± 10.6 vs. 15.7 ± 12.9h; p < 0.001). In multivariable analyses, DGF (OR = 3.31; 95% CI 1.78‒6.30; p < 0.0001) was independent risk factors for TRAS. DM and CIT showed a tendency towards TRAS. The compound discriminatory capacity of the multivariable model (AUC = 0.775; 95% CI 0.718‒0.831) is significantly higher than systolic blood pressure and creatinine alone (AUC = 0.62; 95% CI 0.558–0.661). In body artery stenosis subgroup, DGF (OR = 1.86; 95% CI 1.04‒3.36; p = 0.03) and Diabetes Mellitus (DM) (OR = 2.44; 95% CI 1.31‒4.60; p = 0.005) were independent risk factors for TRAS. Conclusion: In our transplant population, DGF increased more than 3-fold the risk of TRAS. In the subgroup analysis, both DGF and DM increases the risk of body artery stenosis. The addition of other factors to hypertension and renal dysfunction may increase diagnostic accuracy. TRAS Trial registred: clinicaltrials.gov (n° NCT04225338)

Impact of periprocedural myocardial injury after transcatheter aortic valve implantation on long-term mortality: a meta-analysis of Kaplan-Meier derived individual patient data

BackgroundPeriprocedural myocardial injury (PPMI) frequently occurs after transcatheter aortic valve implantation (TAVI), although its impact on long-term mortality is uncertain.MethodsWe performed a pooled analysis of Kaplan-Meier-derived individual patient data to compare survival in patients with and without PPMI after TAVI. Flexible parametric models with B-splines and landmark analyses were used to determine PPMI prognostic value. Subgroup analyses for VARC-2, troponin, and creatine kinase-MB (CK-MB)-defined PPMI were also performed.ResultsEighteen observational studies comprising 10,094 subjects were included. PPMI was associated with lower overall survival (OS) after two years (HR = 1.46, 95% CI 1.30–1.65, p < 0.01). This was also observed when restricting the analysis to overall VARC-2-defined PPMI (HR = 1.23, 95% CI 1.07–1.40, p < 0.01). For VARC-2 PPMI criteria and VARC-2 troponin-only, higher mortality was restricted to the first 2 months after TAVI (HR = 1.64, 95% CI 1.31–2.07, p < 0.01; and HR = 1.32, 95% CI 1.05–1.67, p = 0.02, respectively), while for VARC-2 defined CK-MB-only the increase in mortality was confined to the first 30 days (HR = 7.44, 95% CI 4.76–11.66, p < 0.01).ConclusionPPMI following TAVI was associated with lower overall survival compared with patients without PPMI. PPMI prognostic impact is restricted to the initial months after the procedure. The analyses were consistent for VARC-2 criteria and for both biomarkers, yet CK-MB was a stronger prognostic marker of mortality than troponin

Risck factors of transplant renal artery stenosis in kidney transplant recipients

Introdução: A estenose da artéria do rim transplantado é a principal complicação vascular após o transplante renal. Os preditores de risco geral para essa entidade são mal compreendidos e pouco explorados na literatura médica. Métodos: Análise retrospectiva de pacientes adultos com suspeita de estenose da artéria renal do rim transplantado submetidos a estudo angiográfico em um único centro entre 2007 e 2014. Após angiografia renal, os pacientes foram separados em grupos com estenose da artéria renal e sem estenose (grupo controle). Resultados: 274 pacientes foram submetidos à angiografia renal por suspeita de estenose da artéria renal e 166 foram confirmados. O grupo com estenose apresentava idade mais elevada (46,3 ±11,0 vs. 40,9 ±14,2 anos; p = 0,001), nefropatia hipertensiva mais frequente (30,1% vs. 15,7%; p = 0,01), maior incidência de função do enxerto atrasada (52,0% vs. 25,6%; p <0,001) e maior tempo de isquemia fria (21,5 ± 10,6 vs. 15,7 ± 12,9h; p <0,001). Na análise multivariada, pressão arterial sistólica (OR: 1,02; IC 95%: 1,01-1,03; p = 0,002), função do enxerto atrasada (OR: 3,31; IC 95%: 1,78-6,30; p <0,0001) e creatinina sérica (OR: 1,15; IC95%: 1,02- 1,32; p = 0,035) foram fatores de risco independentes para estenose de artéria renal do rim transplantado. No subgrupo de estenose apenas no corpo da artéria, função do enxerto atrasada (OR: 1,86; IC 95%: 1,04-3,36 p = 0,03) e diabetes mellitus (OR: 2,44; IC 95%: 1,31-4,60 p = 0,005) foram fatores de risco independentes para estenose de artéria renal do rim transplantado. Conclusão: A hipertensão arterial e creatinina sérica elevadas são fatores de risco bem conhecidos para estenose de artéria renal do rim transplantado, porém inespecíficos. A função do enxerto retardada é uma variável forte para esta complicação. Diabetes mellitus e tempo de isquemia frio podem representar fatores de risco.Background: Transplant renal artery stenosis is a recognized vascular complication after kidney transplantation. The overall risk predictors of this complication are poorly understood. Methods: Retrospective analysis of adult patients with suspected stenosis who underwent angiographic study in a single center between 2007 and 2014. After renal angiography, patients were separated into transplant renal artery stenosis group and control group. Results: 274 patients were submitted to a renal angiography due to suspected stenosis and 166 were confirmed. Transplant renal artery stenosis group featured an older population (46.3 ±11.0 vs 40.9 ±14.2 years; p= 0.001), more frequent hypertensive nephropathy (30.1% vs 15.7%; p=0.01), higher incidence of delayed graft function (52.0% vs 25.6%; p<0.001) and longer cold ischemia time (21.5 ±10.6 vs 15.7±12.9h; p<0.001). In multivariable analyses, systolic blood pressure (OR: 1.02; 95% CI: 1.01-1.03; p=0.002), delayed graft function (OR: 3.31; 95%CI: 1.78-6.30; p<0.0001) and serum creatinine (OR: 1.15; 95%CI: 1.02-1.32; p=0.035) were independent risk factors for transplant renal artery stenosis. In body artery stenosis subgroup, delayed graft function (OR: 1.86; 95%CI: 1.04-3.36 p=0.03) and Diabetes Mellitus (OR: 2.44; 95%CI: 1.31-4.60 p=0.005) were independent risk factors for transplant renal artery stenosis. Conclusion: Arterial hypertension and higher serum creatinine are well-known risk factors for transplant renal artery stenosis. Delayed graft function is a strong variable for this complication. Diabetes mellitus and cold ischemia time could represent risk factors.Não recebi financiament