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Abstract: PO2114

Medial Arterial Calcification and Transplant Outcomes

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Vasanth, Payaswini, Emory University School of Medicine, Atlanta, Georgia, United States
  • Yang, Tianen Christopher, Emory University School of Medicine, Atlanta, Georgia, United States
  • O'Neill, W. Charles, Emory University School of Medicine, Atlanta, Georgia, United States
Background

Medial arterial calcification, a disorder distinct from atherosclerosis, is common in ESRD and associated with poor outcomes. Since this lesion does not regress after renal transplantation, it may be associated with poor outcomes in these patients as well. This was tested in a retrospective cohort of females undergoing renal transplantation using breast arterial calcification (BAC) as a specific marker of medial arterial calcification.

Methods

We identified all females with renal transplantation (Tx) through 2017 with digital mammograms performed at this institution. Mammograms were examined for arterial calcification, which was quantified by summing the lengths of calcified arterial segments. BAC was considered present at Tx if present any time prior to Tx or within 1.5 years after Tx. BAC was considered absent if absent within one year before Tx and any time after Tx. Medical records were reviewed for graft loss, cardiovascular disease (CVD: myocardial infarction, amputation, stroke, or any revascularization), and risk factors.

Results

132 patients were identified with qualifying mammograms, which were performed a median of 0.50 years from Tx date. Clinical follow-up ranged from 3-13 years after Tx (mean: 6.4), time to graft loss 1.3-9.4 years (mean: 3.9), and time to CVD event 0.3-7.9 years (mean: 4.1). Patients with BAC (n=58) were older (55 vs. 50, p=0.004), had more diabetes (55 vs. 35%, p=0.02), parathyroidectomies (16 vs. 1.4%, p=0.005), and somewhat more pre-Tx CVD (12 vs. 4.1%, p=0.10). Graft loss (14 vs. 2.7%, p=0.022) and new CVD (21 vs. 5.4%, p=0.014) occurred more frequently in patients with BAC. BAC remained an independent predictor of graft loss in a logistic model including age, prior Tx, pre-Tx CVD, diabetes, and smoking (OR: 8.8; 95% CI: 1.2-62, p=0.029). The effect on CVD was no longer significant when pre-Tx CVD and diabetes were added to a logistic model. CVD was more common in those with BAC above vs. below the median quantity.

Conclusion

Medial arterial calcification was an independent predictor of renal allograft failure. It also predicted post-Tx CVD events but this was largely accounted for by the association with pre-Tx CVD and diabetes. Since all women undergo screening mammography prior to Tx, BAC could be a convenient marker of outcomes and targeting of risk factor modification and should be investigated in a larger cohort.

Funding

  • Clinical Revenue Support