Aorto-Iliac Arterial Stenosis, Kidney Transplant Failure, Peripheral Arterial Disease
Conditions
Keywords
aortoiliac arterial stenosis, peripheral arterial disease, kidney transplantation, outcomes
Brief summary
The impact of aortoiliac stenosis on kidney transplant patients remains unclear. This study aims to investigate the safety and efficacy of kidney transplantation in patients with aortoiliac stenosis.
Detailed description
Kidney transplantation is the optimal treatment for end-stage renal disease (ESRD). Unfortunately, not all ESRD patients are eligible for kidney transplantation. Aortoiliac stenosis, an increasingly common type of peripheral arterial disease in ESRD patients, is considered as relative contra-indication for kidney transplantation. There are several reasons for concern, such as the complexity of the vascular anastomosis and inferior life expectancy. Consequently, it is still debated whether patients with aortoiliac stenosis would benefit from kidney transplantation. This study aimed to supplement current literature on the safety and efficacy of kidney transplantation in patients with aortoiliac stenosis. To achieve this, all patients undergoing kidney transplantation in Erasmus Medical Center between January 2010 and December 2020 were enrolled, and propensity score matching was used to minimize confounding factors. Additionally, long-term graft function was investigated to evaluate the impact of stenosis on graft function.
Interventions
None listed
Sponsors
Erasmus Medical Center
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients who underwent kidney transplantation in the Erasmus Medical Center between January 2010 and December 2020
Exclusion criteria
* Patients who were under 18 years at transplantation * Patients who underwent combined organ transplantation * Patients who had no follow-up
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient Survival | From the date of kidney transplantation till death or data cut-off, whichever came first, assessed up to 10 years. | Patient survival was calculated based on all-cause death from the date of kidney transplantation till the end of follow-up (January, 2023), assessed up to 10 years. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Death-censored Graft Survival | From the date of kidney transplantation till death or data cut-off, whichever came first, assessed up to 10 years. | Death-censored graft survival was calculated based on death-censored graft failure, from the date of kidney transplantation till death or data cut-off, whichever came first, assessed up to 10 years. |
| Graft Function | From the date of kidney transplantation till death or data cut-off, whichever came first, assessed up to 10 years. | Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation at every post transplant year up to 10 years. |
Countries
Netherlands
Participant flow
Recruitment details
We initially identified all patients undergoing kidney transplantation in Erasmus Medical Center between January 2010 and December 2020. The exclusion criteria were age less than 18 years when transplanted, combined organ transplantation, or no follow-up data.
Pre-assignment details
We initially identified 2127 participants. Thirty-six patients were excluded according to the exclusion criteria. In the remaining participants, propensity score matching was performed in a nearest neighbor-matching approach with a maximum caliper of 0.1 in a 1 : 4 ratio to match the baseline characteristics of participants with and without aortoiliac stenosis. The matching parameters included age at transplant, dialysis mode, retransplant, donor type, comorbidities, and smoking status.
Participants by arm
| Arm | Count |
|---|---|
| No-stenosis Group Patients who had no pre-existing aortoiliac stenosis before kidney transplantation. | 524 |
| TASC A/B Stenosis Group Patients who had TASC A/B aortoiliac stenosis before kidney transplantation. | 96 |
| TASC C/D Stenosis Group Patients who had TASC C/D aortoiliac stenosis before kidney transplantation. | 35 |
| Total | 655 |
Baseline characteristics
| Characteristic | No-stenosis Group | TASC C/D Stenosis Group | TASC A/B Stenosis Group | Total |
|---|---|---|---|---|
| Age, Continuous | 66 years | 63 years | 66 years | 66 years |
| BMI | 28 kg/m2 | 28 kg/m2 | 27 kg/m2 | 28 kg/m2 |
| Donor Type DBD | 87 Participants | 6 Participants | 15 Participants | 108 Participants |
| Donor Type DCD | 147 Participants | 14 Participants | 26 Participants | 187 Participants |
| Donor Type Living Donor | 290 Participants | 15 Participants | 55 Participants | 360 Participants |
| Duration of Dialysis | 22 months | 26 months | 22 months | 22 months |
| Race and Ethnicity Not Collected | — | — | — | 0 Participants |
| Retransplant | 87 Participants | 6 Participants | 15 Participants | 108 Participants |
| Sex: Female, Male Female | 169 Participants | 10 Participants | 34 Participants | 213 Participants |
| Sex: Female, Male Male | 355 Participants | 25 Participants | 62 Participants | 442 Participants |
| Smoking Status Current Smoker | 113 Participants | 7 Participants | 21 Participants | 141 Participants |
| Smoking Status Former Smoker | 261 Participants | 15 Participants | 50 Participants | 326 Participants |
| Smoking Status Never Smoker | 150 Participants | 13 Participants | 25 Participants | 188 Participants |
| Type of Dialysis Combined Modality | 38 Participants | 3 Participants | 8 Participants | 49 Participants |
| Type of Dialysis Hemodialysis | 297 Participants | 22 Participants | 52 Participants | 371 Participants |
| Type of Dialysis Peritoneal Dialysis | 69 Participants | 5 Participants | 12 Participants | 86 Participants |
| Type of Dialysis Pre-emptive | 120 Participants | 5 Participants | 24 Participants | 149 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 202 / 524 | 48 / 96 | 29 / 35 |
| other Total, other adverse events | 0 / 524 | 0 / 96 | 0 / 35 |
| serious Total, serious adverse events | 0 / 524 | 0 / 96 | 0 / 35 |
Outcome results
Primary
Patient Survival
Patient survival was calculated based on all-cause death from the date of kidney transplantation till the end of follow-up (January, 2023), assessed up to 10 years.
Time frame: From the date of kidney transplantation till death or data cut-off, whichever came first, assessed up to 10 years.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| No-stenosis Group | Patient Survival | 322 Participants |
| TASC A/B Stenosis | Patient Survival | 48 Participants |
| TASC C/D Stenosis | Patient Survival | 6 Participants |
Secondary
Death-censored Graft Survival
Death-censored graft survival was calculated based on death-censored graft failure, from the date of kidney transplantation till death or data cut-off, whichever came first, assessed up to 10 years.
Time frame: From the date of kidney transplantation till death or data cut-off, whichever came first, assessed up to 10 years.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| No-stenosis Group | Death-censored Graft Survival | 443 Participants |
| TASC A/B Stenosis | Death-censored Graft Survival | 80 Participants |
| TASC C/D Stenosis | Death-censored Graft Survival | 26 Participants |
Secondary
Graft Function
Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation at every post transplant year up to 10 years.
Time frame: From the date of kidney transplantation till death or data cut-off, whichever came first, assessed up to 10 years.
Population: The discrepancy in the number of participants analyzed in one or more rows compared to the overall number of participants was due to attrition from graft failure or patient death over time.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| No-stenosis Group | Graft Function | 6 years posttransplant | 47 mL/min/1.73m2 |
| No-stenosis Group | Graft Function | 2 years posttransplant | 46 mL/min/1.73m2 |
| No-stenosis Group | Graft Function | 4 years posttransplant | 48 mL/min/1.73m2 |
| No-stenosis Group | Graft Function | 8 years posttransplant | 46 mL/min/1.73m2 |
| No-stenosis Group | Graft Function | 5 years posttransplant | 48 mL/min/1.73m2 |
| No-stenosis Group | Graft Function | 3 years posttransplant | 47 mL/min/1.73m2 |
| No-stenosis Group | Graft Function | 10 years posttransplant | 50 mL/min/1.73m2 |
| No-stenosis Group | Graft Function | 7 years posttransplant | 47 mL/min/1.73m2 |
| No-stenosis Group | Graft Function | 1 year posttransplant | 46 mL/min/1.73m2 |
| No-stenosis Group | Graft Function | 9 years posttransplant | 46 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 8 years posttransplant | 50 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 3 years posttransplant | 47 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 1 year posttransplant | 51 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 2 years posttransplant | 50 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 4 years posttransplant | 41 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 5 years posttransplant | 40 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 6 years posttransplant | 46 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 7 years posttransplant | 45 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 9 years posttransplant | 46 mL/min/1.73m2 |
| TASC A/B Stenosis | Graft Function | 10 years posttransplant | 35 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 6 years posttransplant | 46 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 3 years posttransplant | 40 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 8 years posttransplant | 47 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 7 years posttransplant | 40 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 2 years posttransplant | 42 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 4 years posttransplant | 42 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 10 years posttransplant | 48 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 5 years posttransplant | 38 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 1 year posttransplant | 46 mL/min/1.73m2 |
| TASC C/D Stenosis | Graft Function | 9 years posttransplant | 50 mL/min/1.73m2 |