The impact of aorto-iliac stenosis on graft and patient survival in kidney transplant recipients using the TASC II classification.

Abstract

BACKGROUND\nPatients with end-stage renal disease (ESRD) and aorto-iliac stenosis are often considered ineligible for kidney transplantation, even though kidney transplantation has been acknowledged as the best therapy for ESRD. The clinical outcomes of kidney transplantation in patients with aorto-iliac stenosis are not well-studied. This study aimed to assess the impact of aorto-iliac stenosis on graft and patient survival.\n\n\nMETHODS\nThis retrospective, single-center study included kidney transplant recipients transplanted between January 1, 2000 and December 31, 2016 who received contrast-enhanced imaging. Patients with aorto-iliac 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 aorto-iliac stenosis were functioning as controls.\n\n\nRESULTS\nA 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 (HR) 3.96; 95% confidence interval (CI) 1.12-14.04). In multivariable analysis, having a TASC II C/D lesion was an independent risk factor for mortality (HR 3.25; 95% CI 1.87-5.67; p<0.001). Having any TASC II lesion was not a risk factor for graft loss (overall p=0.282).\n\n\nCONCLUSION\nKidney transplantation in patients with TASC II A/B is feasible and safe without increased risk of perioperative mortality. Aorto-iliac stenosis decreases patient survival. Death-censored graft survival is unaffected.