Kidney transplantation: Indices of large arterial function in recipients and donors

Abstract

Although kidney transplantation significantly improves cardiovascular outcome when compared to other renal replacement modalities, cardiovascular risk in transplant patients remains significantly higher than the age- and gender-matched subjects in the general population. In addition to the well-established increase in arteriolar resistance observed in these patients, large artery stiffness, measured by pulse wave velocity and augmentation index, has recently emerged as an equally significant predictor of early cardiovascular disease. Despite the improvement in arterial function conferred by kidney transplantation, large artery stiffness remains high; this has been attributed to recipient-related factors, basically age, gender, cardiovascular risk, and graft function; donor-related factors, namely, age and arterial stiffness; and transplantation-related parameters, mostly acute rejection and immunosuppressive treatment. Even more recently, donor arterial stiffness has been examined to evaluate donor risks post uninephrectomy, but results are still conflicting and a final conclusion is yet to be elucidated. Nonetheless, renal transplantation offers a unique improvement in quality of life for patients with end-stage renal disease without compromising the living donor outcome, and support for the altruistic act of kidney donation should always remain unequivocal.