Abstract
Introduction: Arteriosclerosis is common in candidates for kidney transplantation (KT) due to cardiovascular comorbidities and chronic dialysis. Previous studies have demonstrated the prognostic relevance of pelvic calcification on the surgical outcome after KT. The aim of this study was to evaluate the potential of the computed tomography (CT)-based pelvic calcification score (PCS) as a predictive marker of outcome and survival in KT in a comprehensive analysis. Methods: A prospectively maintained medical database of patients who received KT was used for the present analysis. Calcification in the common and external iliac arteries was analyzed in the CT scan, resulting in a PCS ranking from 0 to 44 points. Receiver operator characteristic curves were generated to determine the optimal diagnostic criterion threshold for predicting postoperative outcomes and survival. Predictive value and association of the PCS with clinicopathological parameters of the donors, recipients, and transplant procedure were analyzed retrospectively. Results: A total of 87 KTs (31 female, 35.6%) were included in the study with an average PCS of 19.8 ± 13.2 (range: 0–40), whereby 18.4% showed no calcification of the pelvic arteries. Recipient age and BMI showed a significant correlation with PCS (recipient age: r = 0.622; p < 0.001; recipient BMI: r = 0.276; p = 0.010). Using a PCS cut-off value of 14, there was an association of PCS with delayed graft function (DGF), graft survival and patient survival in univariate analysis; however, PCS failed to be an independent predictor of DGF, graft survival and patient survival after adjusting for other relevant donor, recipient, and transplant characteristics (DGF: OR 1.95, CI: 0.29–12.24, p = 0.493; graft survival: HR: 1.75, CI: 0.70–14.40; p = 0.133; patient survival: HR: 5.72, CI: 0.73–45.18, p = 0.098). Conclusion: Pelvic calcifications are frequent in patients with KT and found in 81.6% of cases. The PCS is associated with age and BMI and was associated with decreased graft and patient survival. However, PCS fails to be an independent predictor in the multivariable analysis. Larger studies are needed to confirm our preliminary results of the prognostic role of PCS.
