From arterial stiffness to kidney graft microvasculature: Mortality and graft survival within a cohort of 220 kidney transplant recipients

<div><p>Background</p><p>Aortic stiffness assessed by carotid-femoral pulse wave velocity (CF-PWV) is a predictor of mortality in several populations. However, little is known in kidney transplant recipients. Our objectives were to evaluate the ability of CF-PWV measured 3 months following transplantation to predict mortality, graft loss and its potential links to measured Glomerular Filtration Rate (mGFR) or kidney graft microvasculature parameters.</p><p>Methods</p><p>The study is based on a monocentric retrospective cohort including 220 adult kidney graft recipients evaluated three months after transplantation. CF-PWV measures, clinical, laboratory and histological data performed at 3 (M3) and 12 months (M12) following transplantation were retrospectively collected. The two primary endpoints were all-cause mortality and occurrence of end stage renal disease (ESRD) defined by initiation of dialysis.</p><p>Results</p><p>After a median follow up of 5.5 years [1.9; 8.8], death and graft loss occurred in 10 and 12 patients respectively. M3 CF-PWV was an independent mortality risk factor (HR = 1.29 [1.03; 1.61]; p = 0.03), despite no aortic stiffness variation during the first year of transplantation. Of notice, M3 CF-PWV was not associated with M12 mGFR or ESRD outcome. Graft microcirculation assessed by Banff vascular fibrous intimal thickening score (cv) worsened between M3 and M12 (p = 0.01), but no link was found with CF-PWV, mGFR or ESRD outcome. Surprisingly, acute rejections at M3 were associated after adjustment with mortality (p = 0.03) but not ESRD.</p><p>Conclusion</p><p>Aortic stiffness measured 3 months after kidney transplantation is a strong predictor of mortality with no obvious influence on kidney graft microvasculature or graft loss.</p></div

Study flow charts.

<p>Study flow charts.</p

Comparison of clinical and demographical characteristics at baseline according to M3 CF-PWV threshold of 10.6 m/s.

<p>Comparison of clinical and demographical characteristics at baseline according to M3 CF-PWV threshold of 10.6 m/s.</p

Crude hazard ratios (95% IC) of death and ESRD.

<p>Crude hazard ratios (95% IC) of death and ESRD.</p

From arterial stiffness to kidney graft microvasculature: Mortality and graft survival within a cohort of 220 kidney transplant recipients - Fig 2

<p>Unadjusted Kaplan-Meier event curves for all-cause of mortality (a) or kidney graft loss (b) according to M3 CF-PWV threshold of 10.6 m/s.</p

Comparison of arterial and renal parameters according to M3 CF-PWV threshold of 10.6 m/s.

<p>Comparison of arterial and renal parameters according to M3 CF-PWV threshold of 10.6 m/s.</p