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

Rijkse, Elsaline MD1; Kimenai, Hendrikus J.A.N. MD1; Roodnat, Joke I. MD, PhD2; Ten Raa, Sander MD, PhD3; Bijdevaate, Diederik C. MD4; van Dam, Jacob L. MD1; Muller, Kelly MSc1; IJzermans, Jan N.M. MD, PhD1; van der Zijden, Marcus A. MD2; Minnee, Robert C. MD, PhD1

doi: 10.1097/TP.0000000000002635
Original Clinical Science–General
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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.

1 Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

2 Division of Nephrology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

3 Division of Vascular Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

4 Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Received 10 September 2018. Revision received 10 January 2019.

Accepted 11 January 2019.

The authors declare no funding or conflicts of interest.

E.R., H.J.A.N.K., J.N.M.I., and R.C.M. participated in the research design. E.R., H.J.A.N.K., and R.C.M. participated in the writing of the article. E.R., H.J.A.N.K., K.M., M.A.v.d.Z., and R.C.M. participated in the performance of the research. E.R., J.I.R., J.L.v.D., and R.C.M. participated in data analysis.

Correspondence: Robert C. Minnee, MD, PhD, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. (r.minnee@erasmusmc.nl).

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