Bradley Carl Davis MD, Presenter: Nothing to Disclose

Daniele Marin MD, Abstract Co-Author: Nothing to Disclose

Matthew Ellis MD, Abstract Co-Author: Nothing to Disclose

Bradley Collins MD, Abstract Co-Author: Nothing to Disclose

Lynne Michelle Hurwitz MD, Abstract Co-Author: Research Grant, Siemens AG Research Grant, General Electric Company

Charles Yoon Kim MD, Abstract Co-Author: Consultant, CareFusion Corporation Research Grant, Galil Medical Ltd Consultant, Kimberly-Clark Corporation Consultant, Cryolife, Inc

To assess whether a novel composite calcium score of the iliac arteries correlates with outcomes after renal transplantation

Retrospective review of renal transplant recipients who underwent CT scanning of the pelvis within 2 years prior to surgery revealed 131 patients (mean age 52, 75 male, 56 female). A semiquantitive calcium score (0-12) incorporating calcium morphology, length and circumferential involvement was generated for each common and external iliac arteries. Operative and clinical notes were reviewed to determine the complexity of the operation. High complexity operations were defined as those requiring nonstandard technique such as intra-operative vascular surgical consultation, inspection of more than one arterial segment due to concern for suboptimal arterial anastomotic target, or any other adjunct arterial surgery. Additionally, all arterial complications such as arterial dissection, anastomotic stenosis, pseudoaneurysm, or hemorrhage were identified. Laboratory values were reviewed to identify delayed graft function (DGF) (need for dialysis within the first week post transplant) and renal function at 1 year based on the eGFR. Renal allograft survival (based on return to dialysis or retransplant) and patient survival were calculated using the Kaplan-Meier technique. 

Out of 131 patients who underwent renal transplantation with available CT imaging, 38 patients had their allograft anastomosed to an external iliac artery with some degree of calcification. Seven patients had an arterial complication, 23 were classified as high-complexity, and 17 had DGF. A calcium score of 5+ of the anastomosed external iliac artery correlated with significantly higher rates of DGF (25% vs 8%, p=0.015) and high-complexity operations (46 vs 4%, p<0.001). However, the calcium score did not correlate significantly with arterial complications, the 1-year eGFR or graft survival. Patients with any degree of iliac arterial calcification had significantly lower 1-year patient survival after transplant (92% vs 98%, p=0.05, logrank test).

The proposed novel calcium scoring system correlated significantly with renal transplant case complexity and episodes of delayed graft function

Routine pre-transplant CT for arterial calcium scoring may enable optimal artery selection for anastomosis and ensure appropriate operative planning to reduce surgical complexity

Davis, B, Marin, D, Ellis, M, Collins, B, Hurwitz, L, Kim, C, Impact of a Novel CT-based Iliac Artery Calcium Scoring System on Renal Transplant Outcomes.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016230.html