Slow Progression of Aortic Calcification Is a Potential Benefit of Pre-emptive Kidney Transplantation

doi:10.1016/j.transproceed.2017.12.011

Transplantation Proceedings

Volume 50, Issue 1, January–February 2018, Pages 145-149

https://doi.org/10.1016/j.transproceed.2017.12.011 Get rights and content

Highlights

•
PKT is feasible.
•
Potential benefit of PKT is slow progression of aortic calcification.
•
Slow progression of aortic calcification may improve cardiovascular outcomes.

Abstract

Purpose

Pre-emptive kidney transplantation (PKT) is expected to improve graft and cardiovascular event-free survival compared with standard kidney transplantation. Aortic calcification is reported to be closely associated with renal dysfunction and cardiovascular events; however, its implication in PKT recipients remains incompletely explored. This aim of this study was to evaluate whether PKT confers a protective effect on aortic calcification, renal function, graft survival, and cardiovascular event-free survival.

Methods

One hundred adult patients who underwent renal transplantation between January 1996 and March 2016 at Hirosaki University Hospital and Oyokyo Kidney Research Institute were included. Among them, 19 underwent PKT and 81 patients underwent pretransplant dialysis. We retrospectively compared pretransplant and post-transplant aortic calcification index (ACI), renal function (estimated glomerular filtration rate [eGFR]), and graft and cardiovascular event-free survivals between the 2 groups.

Results

The median age of this cohort was 45 years. Preoperative ACI was significantly lower in PKT recipients. There were no significant differences between the 2 groups regarding postoperative eGFR, graft survival, and cardiovascular event-free survival. However, the ACI progression rate (ΔACI/y) was significantly lower in PKT recipients than in those who underwent pretransplant dialysis. Higher ACI was significantly associated with poor cardiovascular event-free survival.

Conclusions

PKT is beneficial in that it contributes to the slow progression of after transplantation. Although we could not observe significant differences in graft and cardiovascular event-free survivals between the 2 groups, slow progression of aortic calcification showed a potential to decrease cardiovascular events in PKT recipients during long-term follow-up.

Section snippets

Study Design

We conducted a retrospective cohort study of recipients of kidney transplantations at 2 centers. This study was conducted in accordance with the ethical standards of the Declaration of Helsinki and approved by the ethical committee of Hirosaki University Graduate School of Medicine (authorization number: 2017-089). For this type of retrospective study, formal consent was not required.

Study Population

In this study, we included 100 consecutive kidney transplantation cases that were performed in Hirosaki

Results

Median age and median follow-up periods of this cohort were 45 years and 52.1 months, respectively. Table 1 lists the clinical characteristics of the patients enrolled in the study. The median age was significantly lower in PKT recipients (47 vs 38 years, P = .044). The number of living kidney transplantation was significantly greater in the PKT group. Preoperative eGFR was significantly higher in PKT recipients (Fig 1A). Postoperative eGFR did not significantly differ between the groups (Fig 1

Discussion

In the present study, we showed aortic calcification and ACI progression rate were significantly higher in non-PKT recipients than in PKT recipients. To the best of our knowledge, this is the first report to demonstrate the association between PKT and aortic calcification. Several studies have addressed the clinical importance of vascular calcification among dialysis patients [6], [10]; however, only a few studies have demonstrated implication of aortic calcification in renal transplant

References (21)

S. Kallab et al.
Indications for and barriers to preemptive kidney transplantation: a review
Transplant Proc
(2010)
M. Oikawa et al.
Safety and effectiveness of marginal donor in living kidney transplantation
Transplantation Proc
(2016)
S. Okuno et al.
Presence of abdominal aortic calcification is significantly associated with all-cause and cardiovascular mortality in maintenance hemodialysis patients
Am J Kidney Dis
(2007)
K. Imanishi et al.
Post-transplant renal function and cardiovascular events are closely associated with the aortic calcification index in renal transplant recipients
Transplant Proc
(2014)
J.D. Hutcheson et al.
Revisiting cardiovascular calcification: a multifaceted disease requiring a multidisciplinary approach
Semin Cell Dev Biol
(2015)
G.O. Jung et al.
Can preemptive kidney transplantation guarantee longer graft survival in living-donor kidney transplantation? Single-center study
Transplant Proc
(2010)
S.K. Akkina et al.
Earlier is not necessarily better in preemptive kidney transplantation
Am J Transplant
(2008)
K.C. Mange et al.
Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors
N Engl J Med
(2001)
B.L. Kasiske et al.
Preemptive kidney transplantation: the advantage and the advantaged
J Am Soc Nephrol
(2002)
A. Shrestha et al.
Quality of life following live donor renal transplantation: a single centre experience
Ann Transplant
(2010)

There are more references available in the full text version of this article.

Cited by (5)

What are the benefits of preemptive versus non-preemptive kidney transplantation? A systematic review and meta-analysis
2023, Transplantation Reviews
Opting for a preemptive kidney transplant (PKT) can help avoid costs and morbidity associated with dialysis. However, while multiple studies have shown clinical benefits of PKT, other studies have not demonstrated this, leading to controversy in the literature regarding the exact benefits of PKT. Therefore, this study aimed to determine the clinical outcomes of PKT versus non-preemptive kidney transplantation (nPKT) in adult patients. Multiple databases were searched up to May 4, 2022. Independent reviewers selected studies for inclusion and extracted relevant data. Risk of bias was assessed using the Downs and Black checklist. Eighty-seven studies including 859,715 adult kidney transplant patients were included the review. The risk of patient death (relative risk [95% confidence interval] 0.74 [0.60–0.91]) was significantly lower in PKT versus nPKT patients for living donor (LD) transplants, whereas the risk of overall graft loss was significantly lower in PKT compared to nPKT patients for both LD (0.72 [0.62–0.83]) as well as deceased donor (DD) transplants (0.80 [0.69–0.92]). The evidence suggests that LD PKT patients have a lower risk of patient death and graft loss compared to nPKT patients, and DD PKT patients have a lower risk of graft loss than nPKT patients.
Outcome of ABO Blood Type–Incompatible Living-Related Donor Kidney Transplantation Under a Contemporary Immunosuppression Strategy in Japan
2020, Transplantation Proceedings
Because of the serious donor shortage in Japan, there is an increasing need for ABO blood type–incompatible kidney transplantation (ABOi-KT) in living-related donor kidney transplantation. We evaluated the outcomes of ABOi-KT performed at our hospitals using a contemporary immunosuppression strategy with low-dose rituximab.
Between June 2006 and April 2019, 107 patients underwent living-related donor kidney transplantation at our hospitals. The patients were divided into ABO-compatible (ABOc) and ABOi groups. The basic immunosuppression regimen differed between the 2 groups in the use of low-dose rituximab and therapeutic apheresis in the ABOi group. We compared graft survival, patient survival, rejection, viral infection, and posttransplant renal function between the 2 groups.
Of 107 recipients, 37 (35%) underwent ABOi-KT. The 5-year graft survival rates in the ABOc and ABOi group were 91% and 100%, respectively. The Kaplan-Meier analyses showed no difference in graft survival (P = .168) or patient survival (P = .873) between the groups. Biopsy-proven rejection in the ABOc and ABOi groups was observed in 13 (19%) and 7 (19%) patients, respectively (P = .965), and viral infection was observed in 21 (30%) and 10 (27%) patients (P = .747), respectively. Renal function by estimated glomerular filtration rate from 1 week to 5 years after transplantation was similar in both groups.
The outcomes of ABOi-KT with low-dose rituximab were comparable with those of ABOc-KT at our hospitals. ABOi-KT with proper immunosuppression may be an option to help resolve the severe donor shortage in Japan.
Living Kidney Transplantation From Marginal Donors Presents Feasible Donor Renal Function Despite Inferior Recipient Renal Function
2020, Transplantation Proceedings
Citation Excerpt :
On the other hand, donor age (P < .001) and donor CCr (P = .001) were selected as predictive factors for the donor postoperative eGFR (Table 3, lower rows). Although significant evidence of kidney transplantation has been accumulated [16–21], the number of transplantations is limited by various factors in many countries. There is an increasing organ shortage problem for kidney transplantation in Japan because of the absence of an organ exchange program and the small number of cadaveric donations [2,5].
Kidney transplantation from marginal donors is an important solution for organ shortage problems. In this study, we evaluated the safety and effectiveness of living kidney transplantation from marginal donors at our hospitals.
Between June 2006 and April 2019, 107 patients underwent living kidney transplantation at our hospitals. Marginal donors were defined as those with 1. age >70 years, 2. hypertension, 3. creatinine clearance <80 mL/min, 4. body mass index >30 kg/m², or 5. hemoglobin A1c >6.2%. We retrospectively compared renal function and its chronological changes between marginal and standard donors. We also compared graft survival and recipient renal function between the groups.
Thirty-one (29%) donors were defined as marginal. The primary reason for being defined as marginal was hypertension (74%). The mean age of the marginal donors (62 ± 10 years) was higher than that of standard donors (52 ± 12 years, P < .001). The estimated glomerular filtration rate (eGFR) before and after transplantation was lower in the marginal group, whereas the decline ratio of eGFR was not different between the marginal and standard donors. Five-year graft survival of transplantations from marginal donors (89%) was not significantly inferior to that from standard donors (95%). Meanwhile, recipient eGFR was lower in transplantation from marginal donors than standard donors from 1 month through 5 years after transplantation.
No significant differences were observed between the groups regarding the decline ratios of donor eGFR and graft survival. Thus, transplantation from marginal donors may be a feasible solution for donor shortage problems.
Contribution of Gut Microbiota-Derived Uremic Toxins to the Cardiovascular System Mineralization
2021, Toxins
Impact of distance between donor and recipient hospitals on cadaveric kidney transplantation outcomes
2019, Clinical and Experimental Nephrology

: This work was supported by a Grant-in-Aid for Scientific Research (No. 15H02563 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, and 17K16771) from the Japan Society for the Promotion of Science.

View full text

Strides in TransplantationKidney transplantationSlow Progression of Aortic Calcification Is a Potential Benefit of Pre-emptive Kidney Transplantation

Highlights

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Study Design

Study Population

Results

Discussion

Transplant Proc

Transplantation Proc

Am J Kidney Dis

Transplant Proc

Semin Cell Dev Biol

Transplant Proc

Am J Transplant

Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors

N Engl J Med

Preemptive kidney transplantation: the advantage and the advantaged

J Am Soc Nephrol

Quality of life following live donor renal transplantation: a single centre experience

Ann Transplant

Strides in Transplantation
Kidney transplantation
Slow Progression of Aortic Calcification Is a Potential Benefit of Pre-emptive Kidney Transplantation