Selective screening imaging of the aortoiliac arterial system in kidney transplant candidates with non‐contrast pelvic computed tomography

2021 ◽  
Author(s):  
Nicholas Onaca ◽  
Eric Martinez ◽  
Johanna Bayer ◽  
Anji Wall ◽  
Hoylan Fernandez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Kidney Transplant ◽  
Arterial System ◽  
Selective Screening ◽  
Transplant Candidates

scholarly journals Prognostic value of fractional flow reserve using computed tomography for predicting major adverse cardiac events and mortality in kidney transplant candidates

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J N D Dahl ◽  
M B N Nielsen ◽  
M B Bottcher ◽  
H B Birn ◽  
P I Ivarsen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Prognostic Information ◽  
Coronary Cta ◽  
Flow Reserve ◽  
Transplant Candidates

Abstract Background Coronary artery disease (CAD) is highly prevalent in patients with severe chronic kidney disease (CKD), it is the leading cause of mortality and morbidity in the short and long term among kidney transplant candidates, and the prevalence of CAD is high even after kidney transplantation. Most institutions recommend non-invasive cardiac tests prior to transplantation. Previous studies have indicated that cardiac screening by coronary computed tomography angiography (CTA) in kidney transplant candidates before transplantation yields both diagnostic and prognostic information. Additional analysis by CT-derived fractional flow reserve (FFRct) may improve diagnostic performance and have prognostic information. Purpose To establish the occurrence of major adverse cardiac events (MACE) and all-cause mortality in kidney transplantation candidates undergoing cardiac screening with coronary CTA with additional FFRct. Methods Coronary CTA scans from 340 consecutive kidney transplant candidates (CKD stage 4–5) undergoing cardiac evaluation with coronary CTA as part of the diagnostic work-up, between February 2011 and September 2019, were evaluated with subsequent FFRct analysis, the FFRct results were not clinically available. Patients were categorized into three groups based on distal FFRct; normal FFRct >0.80, moderate FFRct 0.80 to >0.75, low FFRct ≤0.75. Secondary analysis was performed using lesion specific (≥50% stenosis on coronary CTA) FFRct values, with normal FFRct >0.80 and abnormal ≤0.80. The primary end-point was MACE (cardiac death, cardiac arrest, myocardial infarction or revascularization unrelated to baseline work-up). The secondary end-point was all-cause mortality. End-point and baseline data were identified through patient files and registry data. Results Patients had a median age of 53 [45–63], 63% were men, 31% were on dialysis, the median follow-up time was 3.3 years [2.0–5.1]. During follow-up, MACE occurred in 28 patients (8.2%) and 28 patients (8.2%) died. When adjusting for risk factors and kidney transplantation during follow-up, the primary analysis identified increased risk of MACE in patients with lower distal FFRct compared to patients with FFRct >0.80; FFRct 0.80 to >0.75; Hazard ratio (HR): 1.63 (95% CI: 0.48–5.58; p=0.44), and FFRct with FFRct ≤0.75; HR: 3.27 (95% CI: 1.34–7.96; p<0.01). In the secondary analysis based on lesion-specific FFRct values, a FFRct ≤0.80 was associated with a higher risk of MACE compared to FFRct >0.80; HR 3.21 (95% CI 1.01–10.20, p<0.05). There were no significant differences in mortality between groups. Conclusions In kidney transplant candidates, a low FFRct ≤0.75 was predictive of MACE but not mortality. A lesion-specific approach found similar results with increased risk of MACE in patients with lesion-specific FFRct ≤0.80. Thus, FFRct adds prognostic information to the cardiac evaluation of these patients with severe CKD. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): The Private Company, HeartFlow Inc, Redwood City, Califonia US- sponsored the fractional flow reserve using computed tomography scans, with no exchange of financial meansThe Public, Health Research Fund of the Central Denmark Region.- provided parts of the salary for two authors. FFRct distal values – MACE and Mortality FFRct lesion values – MACE and Mortality

scholarly journals To screen or not to screen? The development of a prediction model for aorto‐iliac stenosis in kidney transplant candidates

2021 ◽  
Author(s):  
Elsaline Rijkse ◽  
Hongchao Qi ◽  
Shabnam Babakry ◽  
Diederik C. Bijdevaate ◽  
Hendrikus J.A.N. Kimenai ◽  
...  
Keyword(s):  
Prediction Model ◽  
Kidney Transplant ◽  
Transplant Candidates

scholarly journals Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

2021 ◽  
pp. 1-8
Author(s):  
Dominik Promny ◽  
Theresa Hauck ◽  
Aijia Cai ◽  
Andreas Arkudas ◽  
Katharina Heller ◽  
...  
Keyword(s):  
Wound Healing ◽  
Kidney Transplantation ◽  
Postoperative Complications ◽  
Kidney Transplant ◽  
Interdisciplinary Approach ◽  
Wound Complications ◽  
Obese Patients ◽  
Patient Cohort ◽  
Transplant Candidates ◽  
Stage Renal Disease

<b><i>Background:</i></b> Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. <b><i>Methods:</i></b> A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. <b><i>Results:</i></b> The median body mass index was 35.2 kg/m<sup>2</sup> (range 28.5–53.0 kg/m<sup>2</sup>) at first transplant-assessment versus 31.0 kg/m<sup>2</sup> (range 28.0–34.4 kg/m<sup>2</sup>) at panniculectomy, and 31.6 kg/m<sup>2</sup> (range 30.3–32.4 kg/m<sup>2</sup>) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. <b><i>Conclusion:</i></b> Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.

scholarly journals Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashwin Radhakrishnan ◽  
Luke C. Pickup ◽  
Anna M. Price ◽  
Jonathan P. Law ◽  
Kirsty C. McGee ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Coronary Microvascular Dysfunction ◽  
Transplant Candidates ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

scholarly journals Accuracy of the median channel shift in the flow cytometry for predicting complement dependent cytotoxicity crossmatching in kidney transplant candidates

2019 ◽  
Vol 52 ◽  
pp. 27-31 ◽  
Author(s):  
Priscila de Moraes ◽  
Iara Fagundes ◽  
Jacqueline Moraes Cardone ◽  
Beatriz Chamun Gil ◽  
Adriane Stefani Silva Kulzer ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Kidney Transplant ◽  
Complement Dependent Cytotoxicity ◽  
Channel Shift ◽  
Transplant Candidates

scholarly journals Obesity in work-up of kidney transplant candidates – review of clinical practice guidelines.

2020 ◽  
Vol 3 (2) ◽  
pp. 72-79
Author(s):  
Małgorzata Dobrzycka ◽  
Piotr Spychalski ◽  
Monika Łącka ◽  
Monika Proczko-Stepaniak ◽  
Łukasz Kaska ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Kidney Transplant ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Transplant Candidates ◽  
Work Up

scholarly journals Effects of induction therapy with alemtuzumab versus antithymocyte globulin among highly sensitized kidney transplant candidates

2016 ◽  
Vol 27 (4) ◽  
pp. 665 ◽  
Author(s):  
Nasrin Motazedian ◽  
Alireza Shamsaeefar ◽  
Jamshid Roozbeh ◽  
Soraya Khajerezae ◽  
Saman Nikeghbalian ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Induction Therapy ◽  
Antithymocyte Globulin ◽  
Transplant Candidates
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