Endothelial Dysfunction and 6-Year Risk of Mortality in Kidney Transplant Recipients
Background. Endothelial dysfunction is an early and potentially reversible stage in the atherosclerotic process. We assessed endothelial dysfunction noninvasively in kidney transplant recipients (KTRs) and evaluated the association with mortality and graft outcomes. Methods. Flow-mediated dilation (...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-01-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001262 |
| _version_ | 1819006334634295296 |
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| author | Nina Elisabeth Langberg, MD Trond G. Jenssen, PhD Anders J. Haugen, PhD Geir Mjøen, PhD Kåre I. Birkeland, PhD Anders Åsberg, PhD Anders Hartmann, PhD Dag Olav Dahle, PhD |
| author_facet | Nina Elisabeth Langberg, MD Trond G. Jenssen, PhD Anders J. Haugen, PhD Geir Mjøen, PhD Kåre I. Birkeland, PhD Anders Åsberg, PhD Anders Hartmann, PhD Dag Olav Dahle, PhD |
| author_sort | Nina Elisabeth Langberg, MD |
| collection | DOAJ |
| description | Background. Endothelial dysfunction is an early and potentially reversible stage in the atherosclerotic process. We assessed endothelial dysfunction noninvasively in kidney transplant recipients (KTRs) and evaluated the association with mortality and graft outcomes.
Methods. Flow-mediated dilation (FMD) was measured in arteria brachialis by ultrasound, with baseline diameters obtained at rest and maximal diameters obtained during reactive hyperemia occurring after 5 min of forearm occlusion. FMD% is the percentage difference of flow-mediated dilation relative to baseline. Endpoints on mortality and graft outcomes were collected from The Norwegian Renal Registry. The distribution of risk according to FMD levels was assessed in Cox regression using a restricted cubic spline function. FMD was dichotomized using receiver operating characteristic analysis to identify optimal cut points at maximal sensitivity and specificity.
Results. From a total of 269 KTRs in 2012, 152 (56.5%) were eligible and examined 10 wk after transplantation, and 145 had successful FMD measurements. During a mean follow-up of 6.5 y, 26 patients died, 11 lost their graft, and 34 experienced either graft loss or death. Mortality increased with lower FMD levels until about 5% dilation and did not change with further reduction in FMD% (P for nonlinearity <0.01). An optimal cut point of FMD ≤5.36% defined impaired endothelial function and FMD% below this level, was associated with fatal outcome, hazard ratio (HR), 9.80 (1.29–74.62), P = 0.03, uncensored graft loss, HR, 7.80 (1.83–33.30), P = 0.01, but an association with death-censored graft loss was lost after adjusting for pulse pressure, HR, 4.58 (0.55–37.92), P = 0.16.
Conclusions. We found that impaired FMD is strongly associated with mortality in KTRs. |
| first_indexed | 2024-12-21T00:07:02Z |
| format | Article |
| id | doaj.art-dc8ae4f1b5a740dbb12428eb811db7b3 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-21T00:07:02Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-dc8ae4f1b5a740dbb12428eb811db7b32022-12-21T19:22:26ZengWolters KluwerTransplantation Direct2373-87312022-01-0181e126210.1097/TXD.0000000000001262202201000-00005Endothelial Dysfunction and 6-Year Risk of Mortality in Kidney Transplant RecipientsNina Elisabeth Langberg, MD0Trond G. Jenssen, PhD1Anders J. Haugen, PhD2Geir Mjøen, PhD3Kåre I. Birkeland, PhD4Anders Åsberg, PhD5Anders Hartmann, PhD6Dag Olav Dahle, PhD71 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.1 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.1 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.1 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.1 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.1 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.1 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.1 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.Background. Endothelial dysfunction is an early and potentially reversible stage in the atherosclerotic process. We assessed endothelial dysfunction noninvasively in kidney transplant recipients (KTRs) and evaluated the association with mortality and graft outcomes. Methods. Flow-mediated dilation (FMD) was measured in arteria brachialis by ultrasound, with baseline diameters obtained at rest and maximal diameters obtained during reactive hyperemia occurring after 5 min of forearm occlusion. FMD% is the percentage difference of flow-mediated dilation relative to baseline. Endpoints on mortality and graft outcomes were collected from The Norwegian Renal Registry. The distribution of risk according to FMD levels was assessed in Cox regression using a restricted cubic spline function. FMD was dichotomized using receiver operating characteristic analysis to identify optimal cut points at maximal sensitivity and specificity. Results. From a total of 269 KTRs in 2012, 152 (56.5%) were eligible and examined 10 wk after transplantation, and 145 had successful FMD measurements. During a mean follow-up of 6.5 y, 26 patients died, 11 lost their graft, and 34 experienced either graft loss or death. Mortality increased with lower FMD levels until about 5% dilation and did not change with further reduction in FMD% (P for nonlinearity <0.01). An optimal cut point of FMD ≤5.36% defined impaired endothelial function and FMD% below this level, was associated with fatal outcome, hazard ratio (HR), 9.80 (1.29–74.62), P = 0.03, uncensored graft loss, HR, 7.80 (1.83–33.30), P = 0.01, but an association with death-censored graft loss was lost after adjusting for pulse pressure, HR, 4.58 (0.55–37.92), P = 0.16. Conclusions. We found that impaired FMD is strongly associated with mortality in KTRs.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001262 |
| spellingShingle | Nina Elisabeth Langberg, MD Trond G. Jenssen, PhD Anders J. Haugen, PhD Geir Mjøen, PhD Kåre I. Birkeland, PhD Anders Åsberg, PhD Anders Hartmann, PhD Dag Olav Dahle, PhD Endothelial Dysfunction and 6-Year Risk of Mortality in Kidney Transplant Recipients Transplantation Direct |
| title | Endothelial Dysfunction and 6-Year Risk of Mortality in Kidney Transplant Recipients |
| title_full | Endothelial Dysfunction and 6-Year Risk of Mortality in Kidney Transplant Recipients |
| title_fullStr | Endothelial Dysfunction and 6-Year Risk of Mortality in Kidney Transplant Recipients |
| title_full_unstemmed | Endothelial Dysfunction and 6-Year Risk of Mortality in Kidney Transplant Recipients |
| title_short | Endothelial Dysfunction and 6-Year Risk of Mortality in Kidney Transplant Recipients |
| title_sort | endothelial dysfunction and 6 year risk of mortality in kidney transplant recipients |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001262 |
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