Some studies suggest that arterial stiffness assessed by pulse wave velocity (PWV) is a risk factor for death in renal transplantation. However, determinants of high PWV are not well known, especially those associated with donor characteristics and immunosuppressive drugs.Design and method:
Prospective cohort study in renal transplant recipients included between october 2012 and march 2015. Carotido-femoral PWV was measured using applanation tonometry (SphygmoCor®).Results:
Overall, 286 patients (age: 52 ± 18, 57.8% men; diabetes: 26.1%, duration of transplantation: 54 ± 73 months; first graft in 88%) were included. Warm ischemia time (WIT) was 52 ± 17 min., cold ischemia time (CIT) was 1013 ± 430 min.; machine perfusion was used in 15.4% of patients. We chose the 75th percentile (i.e. 13.2 m/sec) as the cut-off value for high PWV (PWV was >10 m/sec in half of our population).Results:
In univariate analyses, donor and recipient age at the time of graft, WIT and cardiovascular cause of donor death were associated with high PWV, but not CIT nor the need for machine perfusion use. In multivariate analyses, only donor age (OR: 3.12 [1.23–7.92]; P = 0.0169) and WIT (OR: 1.92 [1.04–3.55], P = 0.0383) were associated with a risk of high PWV.Results:
Among immunosuppressive drugs, calcineurin inhibitors (CNI) were associated with a greater risk (OR: 3.21 [1.42–3.25], P = 0.0048) and mTORi with a lower risk of high PWV (OR: 0.44 [0.21–0.90], P = 0.024), even in multivariate analyses. No significant interaction was noted between CNI and mTORi for the risk of high PWV (OR: 0.66; [0.05–8.06], P = 0.743).Conclusions:
Donor age, warm ischemia time and immunosuppressive drugs affect arterial stiffness in renal transplantation.