4D.05: RECOVERY OF VASCULAR HEALTH AFTER KIDNEY TRANSPLANTATION. (June 2015)

• Record Type: Journal Article
• Authors: Karras, A.; Boutouyrie, P.; Briet, M.; Bozec, E.; Legendre, C.; McMahon, L.; Delahousse, M.
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000467509.83213.f7
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Chronic kidney disease (CKD) is characterized by stiffening, thinning and dilatation of large arteries, leading to a deleterious increase in circumferential wall stress (CWS) and accelerated vascular ageing. Transplantation reverses many pathological features of CKD and improves life expectancy; however, longitudinal studies exploring the impact of kidney transplantation (KT) upon recipient large artery structure and function are scarce. This study was designed to appraise changes in vascular health following kidney allograft transplantation, in particular comparing live with deceased donors. Figure. No caption available. Design and method: Carotid-femoral pulse wave velocity (PWV), and carotid remodelling (CWS and carotid internal diameter, CID) and stiffness were measured at three months (M3) and one year (M12) after KT, in 161 consecutive recipients receiving either a live (LD, n = 49) or a deceased donor (DD, n = 112) allograft. Results: PWV decreased from 10.8 ± 0.2 m/s at M3 to 10.1 ± 0.3 m/s at M12 (p < 0.001). After multivariate adjustment, the PWV reduction was independently associated with LD KT, initial PWV (M3), and change in mean arterial pressure (M3 to M12), p < 0.001 for all. CWS decreased (70 ± 1 vs 64 ± 1 kPa) due mainly to a reduction in CID (6.4 ± 0.1 vs 6.1 ± 0.1 mm) and stiffness (6.6 ± 0.1 vs 6.4 ± 0.1 m/s), p < 0.001 for all. Reductions in CWS were independently associated with live allograft donation (p < 0.001) and with initial CWS (p < 0.001). For DD, changes in both PWV and CWS showed progressively less improvement compared to LD when further classified into standard and extended criteria donors, with minimal improvement observed in the latter group. Importantly, all changes were independent of renal function. Conclusions: The large artery stiffness and maladaptive carotid artery remodelling of CKD is reversed within 12 months of transplantation and appears unrelated to renal function. Improvements are independently associated with live organ donation, severity of initial pathology, and reduction in mean arterial blood pressure. Data also suggest that extended criteria donors may prejudice vascular recovery.