Poster 16. Aorto-iliac calcification is a risk factor for inferior patient and graft survival in kidney transplant recipients; a systematic review and meta-analysis

Thursday 14 march 2019

12:30 - 12:33h

Categories: Klinisch, Postersessie

Parallel session: Postersessies 4 - Clinical

A.A. Rijkse, J.L. van Dam, H.J.A.N. Kimenai, J.N.M. IJzermans, R.C. Minnee

Dept. of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands

Background: While the incidence of transplanting a kidney onto atherosclerotic iliac arteries is becoming more common, little is known about the clinical outcome. We performed a systematic review and meta-analysis to investigate patient and graft survival of kidney transplant recipients with aorto-iliac calcification (AIC) compared to recipients without aorto-iliac calcifications (nAIC).

Methods: We performed a literature search in 5 databases including Embase, Medline, Cochrane, Web of Science and Google Scholar. Articles from January 1st, 2000 until September 11th, 2018 were included. The methodology was in accordance with the PRISMA statement. Relevant outcomes for meta-analysis were patient survival, (death-censored) graft survival and delayed graft function. The survival data for meta-analysis was deduced from Kaplan-Meier curves and presented as a pooled risk ratio using a random effect model. The quality of the evidence was assessed using the GRADE criteria.

Results: Twenty observational studies were identified from which 8 were eligible for meta-analysis. Short term and long term patient survival were significantly decreased in recipients with AIC (1-year patient survival: RR 2.19, 95% CI 1.39-3.44, p<0.001, 5-year patient survival: RR 2.47, 95% CI 1.75-3.48, p<0.001). One-year uncensored graft survival was inferior in recipients with AIC (risk ratio (RR) 3.15, 95% confidence interval (CI) 1.30-7.64, p=0.01). However, the 1-year and 3-year death-censored graft survival was similar in recipients with and without AIC (1-year: RR 2.26, 95% CI 0.58-8.82, p=0.24, 3-year: RR 2.19, 95% CI 0.49-9.82, p=0.31). The risk of delayed graft function was not increased in recipients with AIC (RR 1.124, 95% CI 0.98-1.58). Mean 1-year patient survival, uncensored graft survival and death-censored graft survival in recipients who received a kidney transplant on a prosthetic graft was 93.5%, 93.5% and 89.1% respectively. The quality of the evidence was graded as low or very low.

Conclusions: Patient and uncensored graft survival is significantly inferior in kidney transplant recipients with AIC. Death-censored graft survival is unaffected. The short term results of kidney transplantation on a prosthetic graft seems favorable.