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Outcomes of EVAR in Kidney Transplant Recipients: Results form a National Quality Initiative.

I. Bostock,1 D. Zarkowsky,1 D. Stone,1 M. Eslami,2 M. Malas,3 P. Goodney.1

1Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
2Vascular Surgery, Boston Medical Center, Boston, MA
3School of Public Health, John Hopkins Medical School, Baltimore, MD.

Meeting: 2016 American Transplant Congress

Abstract number: B227

Keywords: Vascular disease

Session Information

Date: Sunday, June 12, 2016

Session Name: Poster Session B: Kidney: Cardiovascular and Metabolic

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

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  • Deleterious Effects in Kidney Transplant Outcomes With Pre-Organ Procurement Iodine Contrast Exposure
  • Quality Improvement Initiative to Provide Comprehensive Pharmacy Services to Kidney Transplant Patients at a Small Transplant Center.

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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To cite this abstract in AMA style:

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. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-evar-in-kidney-transplant-recipients-results-form-a-national-quality-initiative/. Accessed February 26, 2021.

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