Impact of Aortoiliac Stenosis on Graft and Patient Survival in Kidney Transplant Recipients Using the TASC II Classification

Abstract

Background. Patients with end-stage renal disease and aortoiliac stenosis are often considered ineligible for kidney transplantation, although kidney transplantation has been acknowledged as the best therapy for end-stage renal disease. The clinical outcomes of kidney transplantation in patients with aortoiliac stenosis are not well-studied. This study aimed to assess the impact of aortoiliac stenosis on graft and patient survival. Methods. This retrospective, single-center study included kidney transplant recipients transplanted between January 1, 2000, and December 31, 2016, who received contrast-enhanced imaging. Patients with aortoiliac stenosis were classified using the Trans-Atlantic Inter-Society Consensus (TASC) II classification and categorized as having TASC II A/B lesions or having TASC II C/D lesions. Patients without aortoiliac stenosis were functioning as controls. Results. A total number of 374 patients was included in this study (n = 88 with TASC II lesions, n = 286 as controls). Death-censored graft survival was similar to the controls. Patient and uncensored graft survival was decreased in patients with TASC II C/D lesions (log-rank test P < 0.001). Patients with TASC II C/D lesions had a higher risk of 90-day mortality (hazard ratio, 3.96; 95% confidence interval, 1.12–14.04). In multivariable analysis, having a TASC II C/D lesion was an independent risk factor for mortality (hazard ratio, 3.25; 95% confidence interval, 1.87–5.67; P < 0.001). Having any TASC II lesion was not a risk factor for graft loss (overall P = 0.282). Conclusions. Kidney transplantation in patients with TASC II A/B is feasible and safe without increased risk of perioperative mortality. TASC II C/D decreases patient survival. Death-censored graft survival is unaffected.

The prognosis of kidney transplant recipients with aorto‐iliac calcification: a systematic review and meta‐analysis

“…The pooled RR showed no significant higher risk of graft failure in KTR with VC ( n = 212; RR: 3.41; 95% CI 0.97–11.96; P = 0.05) . Rijkse et al also found a significant graft survival difference between KTR with a TASC II C/D lesion in comparison to KTR without any TASC II lesions (5‐year graft survival: no TASC II lesions: 60%, TASC II C/D lesion: 22%, log‐rank test: P < 0.001).…”

“…They found a statistical significant difference with an incidence of 6.5% in KTR without VC and 21.7% in KTR with any VC ( P = 0.035) . Rijkse et al found that, among deceased patients, death from a cardiovascular cause was more frequent in patients with any TASC II lesion (any TASC II lesion: 35.4%, no TASC II lesion 19.1%, P = 0.035) .…”

“…No difference was found for patient survival between quartiles after a mean follow‐up of 4.18 ± 1.64 years . Rijkse et al investigated the impact of aorto‐iliac stenosis classified with the TASC II classification within a retrospective cohort study. They found a significantly decreased patient survival in patients with TASC II C/D lesions with a 5‐year survival of 66% in the TASC II A/B group, 26% in the TASC II C/D group and 72% in the control group without stenosis (log‐rank test TASC II A/B: P = 0.078, TASC II C/D: P < 0.001).…”

“…They found a significantly decreased patient survival in patients with TASC II C/D lesions with a 5‐year survival of 66% in the TASC II A/B group, 26% in the TASC II C/D group and 72% in the control group without stenosis (log‐rank test TASC II A/B: P = 0.078, TASC II C/D: P < 0.001). After adjustment for various confounders, having a TASC II C/D lesion was a strong, independent risk factor for mortality (HR 3.25; 95% CI 1.87–5.67; P < 0.001) . Four studies also investigated causes of death between patients with any degree of VC and no VC.…”

“…Hwang et al found a significant difference in overall death‐censored graft survival between patients with positive intimal calcification in comparison with patients with negative intimal micro‐calcification (log‐rank test P = 0.017). Rijkse et al found no significant association between the presence of aorto‐iliac stenosis as classified with the TASC II classification and death‐censored graft loss [TASC II A/B: HR 0.78 (0.41–1.50), TASC II C/D: HR 1.85 (0.74–4.65)].…”