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 Cognitive Function, Access to Kidney Transplantation, and Waitlist Mortality Among Kidney Transplant Candidates With or Without Diabetes

2020 ◽  
Vol 76 (1) ◽  
pp. 72-81 ◽  
Author(s):  
Nadia M. Chu ◽  
Zhan Shi ◽  
Christine E. Haugen ◽  
Silas P. Norman ◽  
Alden L. Gross ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Cognitive Function ◽  
Kidney Transplant ◽  
Transplant Candidates ◽  
Waitlist Mortality

MANAGEMENT OF HYPERPARATHYROIDISM IN KIDNEY TRANSPLANTATION CANDIDATES: A NEED FOR CONSENSUS

2020 ◽  
Vol 26 (3) ◽  
pp. 299-304 ◽  
Author(s):  
Hubert Golingan ◽  
Shenae K. Samuels ◽  
Pauline Camacho ◽  
Darshana M. Dadhania ◽  
Fernando E. Pedraza-Taborda ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Transplantation ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Kidney Transplant ◽  
American Association ◽  
The United States ◽  
Standards Of Care ◽  
Endocrine Surgery ◽  
Transplant Candidates

Objective: To assess the evolving standards of care for hyperparathyroidism in kidney transplant candidates. Methods: An 11-question, Institutional Review Board–approved survey was designed and reviewed by multiple institutions. The questionnaire was made available to the American Society of Transplantation's Kidney Pancreas Community of Practice membership via their online hub from April through July 2019. Results: Twenty percent (n = 41) of kidney transplant centers responded out of 202 programs in the United States. Forty-one percent (n = 17) of respondents believed medical literature supports the concept that a serum parathyroid hormone level greater than 800 pg/mL could endanger the survival of a transplanted kidney and therefore makes transplantation in an affected patient relatively or absolutely contraindicated. Sixty-six percent (n = 27) said they occasionally recommend parathyroidectomy for secondary hyperparathyroidism prior to transplantation, and 66% (n = 27) recommend parathyroidectomy after transplantation based on persistent, unsatisfactory posttransplantation parathyroid hormone levels. Forty-six percent (n = 19) prefer subtotal parathyroidectomy as their choice; 44% (n = 18) had no standard preference. Endocrine surgery and otolaryngology were the most common surgical specialties consulted to perform parathyroidectomy in kidney transplant candidates. The majority of respondents (71%, n = 29) do not involve endocrinologists in the management of kidney transplantation candidates. Conclusion: Our survey shows wide divergence of clinical practice in the area of surgical management of kidney transplantation candidates with hyperparathyroidism. We suggest that medical/surgical societies involved in the transplantation care spectrum convene a multidisciplinary group of experts to create a new section in the kidney transplantation guidelines addressing the collaborative management of parathyroid disease in transplantation candidates. Abbreviations: AACE = American Association of Clinical Endocrinologists; AAES = American Association of Endocrine Surgeons; AHNS = American Head and Neck Society; CKD = chronic kidney disease; CKD-MBD = chronic kidney disease–mineral and bone disorder; ESRD = end-stage renal disease; HPT = hyperparathyroidism; KDIGO = Kidney Disease Improving Global Outcomes; KT = kidney transplantation; KTC = kidney transplant candidate; PTH = parathyroid hormone; PTX = parathyroidectomy; US = ultrasonography

scholarly journals Frailty and Access to Kidney Transplantation

2019 ◽  
Vol 14 (4) ◽  
pp. 576-582 ◽  
Author(s):  
Christine E. Haugen ◽  
Nadia M. Chu ◽  
Hao Ying ◽  
Fatima Warsame ◽  
Courtenay M. Holscher ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Confidence Interval ◽  
Kidney Transplant ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Activity Level ◽  
Frailty Status ◽  
Poor Cognitive Function ◽  
Transplant Candidates ◽  
Poor Outcomes

Background and objectivesFrailty, a syndrome distinct from comorbidity and disability, is clinically manifested as a decreased resistance to stressors and is present in up to 35% of patient with ESKD. It is associated with falls, hospitalizations, poor cognitive function, and mortality. Also, frailty is associated with poor outcomes after kidney transplant, including delirium and mortality. Frailty is likely also associated with decreased access to kidney transplantation, given its association with poor outcomes on dialysis and post-transplant. Yet, clinicians have difficulty identifying which patients are frail; therefore, we sought to quantify if frail kidney transplant candidates had similar access to kidney transplantation as nonfrail candidates.Design, setting, participants, & measurementsWe studied 7078 kidney transplant candidates (2009–2018) in a three-center prospective cohort study of frailty. Fried frailty (unintentional weight loss, grip strength, walking speed, exhaustion, and activity level) was measured at outpatient kidney transplant evaluation. We estimated time to listing and transplant rate by frailty status using Cox proportional hazards and Poisson regression, adjusting for demographic and health factors.ResultsThe mean age was 54 years (SD 13; range, 18–89), 40% were women, 34% were black, and 21% were frail. Frail participants were almost half as likely to be listed for kidney transplantation (hazard ratio, 0.62; 95% confidence interval, 0.56 to 0.69; P<0.001) compared with nonfrail participants, independent of age and other demographic factors. Furthermore, frail candidates were transplanted 32% less frequently than nonfrail candidates (incidence rate ratio, 0.68; 95% confidence interval, 0.58 to 0.81; P<0.001).ConclusionsFrailty is associated with lower chance of listing and lower rate of transplant, and is a potentially modifiable risk factor.

scholarly journals P1622GROWTH DIFFERENTIATION FACTOR 15: A BIOMARKER WITH HIGH CLINICAL POTENTIAL IN THE EVALUATION OF KIDNEY TRANSPLANT CANDIDATES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marina De Cos Gomez ◽  
Adalberto Benito Hernandez ◽  
M Angeles Ramos Barron ◽  
Covadonga Lopez del Moral Cuesta ◽  
Jaime Mazon Ruiz ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Kidney Transplantation ◽  
Coronary Artery ◽  
High Risk ◽  
Vascular Disease ◽  
Kidney Transplant ◽  
Enzyme Linked Immunosorbent Assay ◽  
Differentiation Factor ◽  
Artery Disease ◽  
Transplant Candidates

Abstract Background and Aims Kidney transplantation results a significant improvement in patient survival. Nevertheless, mortality the first years after transplant remains relatively high, being mostly related to cardiovascular (CV) events. The selection of patients for kidney transplantation includes a general assessment focused on CV status. In spite of that, due to the complexity and heterogeneity of mechanisms leading to vascular disease in this population (not exclusively related to traditional CV risk factors and pathogenesis), this evaluation remains insufficient and not particularly effective. During the last years different strategies have been studied to stratify potential receptors better and optimize organ allocation, including the development of clinical prognostic scores and novel biomarkers. Growth differentiation factor 15 (GDF-15) is a stress-responsive member of the TGF-β family. Although its mechanism of action is not completely understood, it acts as a cytokine with effects in regulation of inflammation, metabolism and senescence. In the recent years, interest has arisen regarding its use as a biomarker for diagnosis, prognosis and risk stratification in multiple scenarios. Encouraging results have shown its utility as a biomarker of mortality (all cause and CV), heart failure and acute coronary syndrome in different populations. The aim of this work is to assess the utility of GDF-15 to predict survival in kidney transplant candidates. Method 395 kidney transplant recipients between 2005 and 2015 were included. GDF-15 measurements were performed from stored serum samples obtained pretransplant. The concentration of GDF-15 was analyzed using an enzyme-linked immunosorbent assay (Quantikine, R&D Systems). Results Patient characteristics are shown in Table 1. The median GDF-15 was 5331.3 (50.49-16242.3) pg/ml. After a mean of 90.6 ± 41.5 months of follow up 82 (20.8%) patients died. Patients were stratified in tertiles according to GDF-15 levels: low (GDF-15 ≤ 4612.1 pg/ml), medium (GDF-15 4612.1-6296.5 pg/ml) and high risk tertile (GDF-15 &gt; 6296.5 pg/ml). Higher GDF-15 concentrations were significantly associated with mortality: HR 2.16 95%CI (1.14-1.44), p = 0.018 for medium tertile and HR 3.28 95%CI (1.79-6.1), p &lt;0.001 for high risk tertile (Figure 1). After adjusting for age, diabetes, coronary artery disease, peripheral vascular disease, non-renal solid organ transplant and dialysis at the time of transplant, the relation between survival and GDF-15 was significant (HR 2.24 95%CI (1.2-4.16), p = 0.011 for high risk tertile). After adjusting by EPTS (Estimated Post Transplant Survival score) the association with GDF-15 remained significant: HR 3.24 95%CI (1.2-8.8), p = 0.021 for medium risk tertile and HR 4.3 95%CI (1.65-11.54), p = 0.003 for high risk tertile (calculated only in first renal transplants). Mortality at 3 years was 6.9% (27 patients) and it was only related to coronary artery disease and GDF-15 (OR 7.1 95%CI (1.6-32.1), p = 0.01 for high risk tertile) after adjustment. Conclusion In our cohort, higher GDF-15 levels were independently associated with mortality in kidney transplant candidates. This study suggests that GDF-15 may be useful in stratifying recipient risk, adding value to the prognostic tools already available in clinical practice. Further work is needed to confirm these findings and elucidate the mechanisms linking this protein with mortality and CV disease in patients with CKD.

Impact of obesity in kidney transplantation: a prospective cohort study from French registries between 2008 and 2014

2021 ◽  
Author(s):  
Clarisse Grèze ◽  
Bruno Pereira ◽  
Yves Boirie ◽  
Laurent Guy ◽  
Clémentine Millet ◽  
...  
Keyword(s):  
Weight Loss ◽  
Cohort Study ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Patient Survival ◽  
Survival Rates ◽  
Obese Patients

Abstract Background The access of obese patients to kidney transplantation is limited despite several studies showing that obese transplant recipients had a better survival rate than those undergoing dialysis. The aim of this study was to compare patient and graft survival rates and post-renal transplant complications in obese patients and non-obese patients and to assess the effect of pre-transplant weight loss in obese patients on transplant outcomes. Methods We carried out a prospective cohort study using two French registries REIN and CRISTAL on 7 270 kidney transplant patients between 2008 and 2014 in France. We compared obese patients with non-obese patients and obese patients who lost more than 10% of weight before the transplant (Obese WL and Obese nWL). Results The mean BMI in our obese patients was 32 kg/m2. Graft survival was lower in obese patients than in non-obese patients (HR = 1.40, IC 95% [1.09; 1.78], P = 0.007) whereas patient survival was similar (HR = 0.94, IC 95% [0.73; 1.23], P = 0.66). Graft survival was significantly lower in Obese WL than in Obese nWL (HR = 2.17, CI 95% [1.02; 4.63], P = 0.045) whereas patient survival was similar in the two groups (HR = 0.79, IC 95% [0.35; 1.77], P = 0.56). Conclusion Grade I obesity does not seem to be a risk factor for excess mortality after kidney transplantation and should not be an obstacle to having access to a graft. Weight loss before a kidney transplant in this patients should not be essential for registration on waiting list.

scholarly journals 1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S652-S653
Author(s):  
Ruth O Adekunle ◽  
Rebecca Zhang ◽  
Zhensheng Wang ◽  
Rachel Patzer ◽  
Aneesh Mehta
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Categorical Variables ◽  
Persons Living With Hiv ◽  
Stage Renal Disease ◽  
End Stage ◽  
Living With Hiv ◽  
Hiv Negative

Abstract Background As persons living with HIV (PLWH) live longer, end-stage renal disease (ESRD) is emerging as a significant cause of morbidity and mortality. PLWH had a three-fold increased risk of ESRD, while also experiencing lower survival rates on dialysis compared with the general population. There are limited data on the incidence and prevalence of PLWH on dialysis. Our objective was to determine the incidence of PLWH on dialysis in ESRD Network 6 (GA, NC, SC) and assess their referral to kidney transplantation and waitlisting on the deceased donor waiting list. Methods We merged data from the Southeast Transplant Referral Dataset with the United States Renal Data System Medicare Part D Prescription Claims. PLWH were defined as having a prescription for antiretroviral medications or primary cause of ESRD being HIV-associated nephropathy. Descriptive analysis was performed using Student’s t-test for continuous variables and chi-squared test for categorical variables. Results The dataset contained 24,587 patients (471 HIV positive) that initiated an ESRD service between 2012 and 2015. Incidence of PLWH on dialysis was 1.92%. Compared with HIV negative persons, PLWH were younger (median age 49 vs. 58, P < 0.001) and more often black (90% vs. 57%, P < 0.001). There were similar rates of referral among PLWH and HIV-negative persons (50% vs. 51%, P = 0.81), though PLWH were statistical significantly less likely to be waitlisted (8% vs. 15%, P < 0.001). PLWH had longer median time to be referred (240 days vs. 147 days, P < 0.001) and waitlisted compared with HIV-negative persons (611 days vs. 420 days, P = 0.04). Conclusion This pilot study offers the first ESRD Network-level characterization of PLWH receiving an ESRD service proceeding through the steps of kidney transplantation. PLWH were less likely to traverse the steps of kidney transplant compared with those HIV negative, highlighting the need for targeted interventions to improve access to kidney transplant in PLWH. Disclosures All authors: No reported disclosures.

scholarly journals Benefits of vacuum-assisted closure therapy over standard treatments for infected and chronic non-healing wounds after kidney transplantation

2021 ◽  
Vol 23 (1) ◽  
pp. 24-29
Author(s):  
A. V. Shabunin ◽  
I. P. Parfenov ◽  
P. A. Drozdov ◽  
O. D. Podkosov ◽  
O. V. Paklina ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Postoperative Complications ◽  
Wound Complications ◽  
Klebsiella Pneumonia ◽  
Vacuum Assisted Closure ◽  
Vac Therapy ◽  
Group I ◽  
Healing Wounds ◽  
Group 2 ◽  
Group 1

Objective: to evaluate the effectiveness of vacuum-assisted closure (VAC) therapy in comparison with standard treatments for infected and chronic non-healing wounds after kidney transplantation. Materials and methods. From June 2018 to November 2019, 75 kidney transplants from deceased donors were performed at the Transplantation Ward of Botkin City Clinical Hospital. There were 47 men (62.6%) and 28 women (37.4%). Standard surgical technique was used. Immunosuppressive therapy was carried out according to a three-component scheme with anti-CD25 monoclonal antibody induction (basiliximab) intraoperatively and on day 4. All patients received antibiotic therapy with protected third-generation cephalosporins for 7 days after surgery. Postoperative complications were evaluated according to the Clavien-Dindo classification. Standard methods, including daily dressings using modern dressing materials (group I) and VAC therapy (group II) were used for treating infected and chronic non-healing wounds. Results. 30-day mortality in the postoperative period was zero. Postoperative complications were recorded in 11 patients (14.6%), of which 7 had postoperative wound complications. Group I included 3 patients (1 with a Klebsiella pneumonia-infected wound and 2 with chronic non-healing wounds and no microflora growth). Group 2 had 4 patients (3 with infected wounds (Esherichia coli - 1, Klebsiella pneumonia - 2) and 1 with chronic non-healing wound). Complete cleansing of wound, absence of bacterial growth according to the microbiological examination, and maturation of granulations according to histological examination were considered as the criteria upon which a wound could be sutured in both groups of patients. The average time between the start of treatment and secondary suturing in group 1 patients was 33.11 ± 5.43 (28-37) and 15.01 ± 3.15 (13-17) days in group 1 and group 2 respectively. Conclusion. VAC therapy in patients with wound complications resulting from kidney transplantation, in comparison with standard treatment, can achieve rapid wound cleansing, acute inflammation relief and accelerated maturation of mature granulation tissue, thereby improving treatment outcomes in this category of patients.

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 &gt;0.80, moderate FFRct 0.80 to &gt;0.75, low FFRct ≤0.75. Secondary analysis was performed using lesion specific (≥50% stenosis on coronary CTA) FFRct values, with normal FFRct &gt;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 &gt;0.80; FFRct 0.80 to &gt;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&lt;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 &gt;0.80; HR 3.21 (95% CI 1.01–10.20, p&lt;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

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