BACKGROUND:

Contrast-induced nephropathy following endovascular aortic aneurysm repair (EVAR) in renal transplant patients can have devastating consequences. We describe outcomes within a national cohort of kidney transplant recipients treated with EVAR.

METHODS:

The Vascular Quality Initiative (VQI) database was queried to select all kidney transplant recipients who underwent EVAR between 01/2003 and 12/2014. Our primary outcome was renal dysfunction, defined as acute kidney injury (AKI; elevation of serum creatinine >0.5 g/dl from baseline), or new post-operative hemodialysis (HD) requirement. We also examined the use of iodinated contrast during EVAR by studying the iodine/eGFR ratio, defined as the amount of contrast (iodine [g]) used relative to renal clearance.

RESULTS:

Within the EVAR VQI dataset, 40 patients were renal transplant recipients (40/17,213, 0.2%). Renal dysfunction occurred in 5/40 patients in the transplanted group in comparison to 779/17,173 patients in the non-transplanted group (12.5% versus 4.5%, p<0.01). Emergent EVAR was required in 2 (5%) patients, one of whom required dialysis after surgery and subsequently died. One-year survival after EVAR was similar between renal transplant patients compared to those with native kidneys (92.9% versus 93.1%, p=0.73). In contrast to transplant patients who did not develop renal dysfunction, transplanted patients who developed renal dysfunction had significantly lower pre-operative eGFR's (29.5 vs. 54.7 p=0.007) and a significantly higher iodine/eGFR ratio (0.78 vs. 0.39 p=0.02) despite receiving a statistically similar volume of contrast (70.0 vs. 68.8 p=0.97).

CONCLUSIONS:

Renal dysfunction is 3 times more frequent in kidney transplant patients treated with EVAR than in non-transplanted patients, though overall survival did not differ between groups. Decreased pre-operative eGFR and higher iodine/eGFR ratio are associated with post-operative renal dysfunction following EVAR within the transplant population. Limiting contrast dosing relative to pre-operative eGFR, in addition to limiting contrast volume, may help prevent contrast-induced nephropathy in transplant recipients undergoing EVAR.

CITATION INFORMATION: Bostock I, Zarkowsky D, Stone D, Eslami M, Malas M, Goodney P. Outcomes of EVAR in Kidney Transplant Recipients: Results form a National Quality Initiative. Am J Transplant. 2016;16 (suppl 3).

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