Impact of Aortoiliac Stenosis on Graft and Patient Survival in Kidney Transplant Recipients Using the TASC II Classification

Transplantation. 2019 Oct;103(10):2164-2172. doi: 10.1097/TP.0000000000002635.


Background: Patients with end-stage renal disease and aortoiliac stenosis are often considered ineligible for kidney transplantation, although kidney transplantation has been acknowledged as the best therapy for end-stage renal disease. The clinical outcomes of kidney transplantation in patients with aortoiliac stenosis are not well-studied. This study aimed to assess the impact of aortoiliac stenosis on graft and patient survival.

Methods: This retrospective, single-center study included kidney transplant recipients transplanted between January 1, 2000, and December 31, 2016, who received contrast-enhanced imaging. Patients with aortoiliac stenosis were classified using the Trans-Atlantic Inter-Society Consensus (TASC) II classification and categorized as having TASC II A/B lesions or having TASC II C/D lesions. Patients without aortoiliac stenosis were functioning as controls.

Results: A total number of 374 patients was included in this study (n = 88 with TASC II lesions, n = 286 as controls). Death-censored graft survival was similar to the controls. Patient and uncensored graft survival was decreased in patients with TASC II C/D lesions (log-rank test P < 0.001). Patients with TASC II C/D lesions had a higher risk of 90-day mortality (hazard ratio, 3.96; 95% confidence interval, 1.12-14.04). In multivariable analysis, having a TASC II C/D lesion was an independent risk factor for mortality (hazard ratio, 3.25; 95% confidence interval, 1.87-5.67; P < 0.001). Having any TASC II lesion was not a risk factor for graft loss (overall P = 0.282).

Conclusions: Kidney transplantation in patients with TASC II A/B is feasible and safe without increased risk of perioperative mortality. TASC II C/D decreases patient survival. Death-censored graft survival is unaffected.

MeSH terms

  • Aged
  • Angiography
  • Aorta / diagnostic imaging
  • Aorta / pathology
  • Aortic Diseases / complications*
  • Aortic Diseases / diagnosis
  • Aortic Diseases / pathology
  • Arterial Occlusive Diseases / complications*
  • Arterial Occlusive Diseases / diagnosis
  • Arterial Occlusive Diseases / pathology
  • Constriction, Pathologic / complications
  • Constriction, Pathologic / diagnosis
  • Constriction, Pathologic / pathology
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Graft Survival*
  • Humans
  • Iliac Artery / diagnostic imaging
  • Iliac Artery / pathology
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / standards
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Perioperative Period / mortality
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Treatment Outcome