Indices of systemic atherosclerosis are superior to ultrasound resistance indices for prediction of allograft survival.
BACKGROUND
In renal allograft recipients, ultrasound resistance indices (RI) have been discussed as predictors of transplant survival. RI measurements are correlated with subclinical atherosclerosis. It is thus unclear whether RI measurements represent specific markers of allograft damage or merely reflect systemic vascular damage. We studied whether RI are superior outcome predictors compared to markers of subclinical atherosclerosis and global cardiovascular risk.


METHODS
In 105 renal transplant patients, intrarenal RI and common carotid intima-media thickness (IMT) were measured. Risk for coronary heart disease was determined by Framingham risk scoring (FRS). Patients were followed up for 5.4 +/- 0.4 years. The combined end point was a decrease of > or =50% in estimated glomerular filtration rate, need for dialysis or death.


RESULTS
Both an increased IMT and a high FRS were predictors of the combined end point. In contrast, increased RI did not significantly predict the combined end point in the entire cohort. Only among low-risk patients with either normal IMT or FRS < or =20%, high RI measurements were associated with allograft loss.


CONCLUSIONS
Compared to markers of cardiovascular risk or systemic atherosclerosis, renal RI are inferior outcome predictors in unselected transplant recipients. Only in patients with mild or moderate cardiovascular risk may RI measurements allow additional risk stratification.
Gerhart
Markus K
MK
Department of Internal Medicine IV, University of Saarland, Homburg, Germany.
Seiler
Sarah
S
Grün
Oliver S
OS
Rogacev
Kyrill S
KS
Fliser
Danilo
D
Heine
Gunnar H
GH
D001161:Arteriosclerosis / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015996:Survival Rate; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance