Arterial changes in renal transplantation

Abstract

Renal transplantation is the best renal replacement modality for patients with end-stage renal disease in terms of patient survival and quality of life. Despite substantial improvement in recipient outcome, stiffness of the large arterial system and cardiovascular (CV) mortality remain high compared to age- and sex-matched subjects in the general population. In addition to traditional CV risk factors, transplantation-specific parameters emerge and are related to immune interactions, drug specifications, and donor characteristics. Some of these parameters appear to be modulators of risk factors and graft and recipient outcome. Acute rejection, for example, appears as a major and independent determinant of high arterial stiffness in recipients of kidney grafts. Furthermore, past history of CV events, low graft filtration function, and donor age determine long-term patient and graft outcome. Living kidney donors, on the other hand, are normally protected especially that they are carefully selected prior to transplantation. Despite a similar long-term outcome compared to the general population, donors may be at higher risk for stiffening of the large arterial system, especially if they cluster with time, CV comorbidities.