title: Clinical significance of preexisting microcalcification in the iliac artery in renal transplant recipients.
abstract: BACKGROUND
  The clinical significance of preexisting microcalcification in the iliac artery is undetermined in renal transplant recipients.
  
  
  METHODS
  We obtained iliac artery segments from 90 transplant recipients at the time of renal transplantation and performed von Kossa staining for microcalcification. The clinical significance of intimal microcalcification was evaluated with allograft survival rate, rate of graft function decline, and composite of any cardiovascular event or patient death. Expression of fetuin-A and C-reactive protein, key regulators of calcification, was also investigated in the iliac artery.
  
  
  RESULTS
  Intimal microcalcification was positive in 48 (53.3%) patients, and its intensity was correlated positively with intimal C-reactive protein intensity (P = 0.019). Allograft survival in patients positive for intimal microcalcification was lower than patients who were negative (P = 0.017). The patients with positivity for both intimal microcalcification and fetuin-A showed lower allograft survival rate than patients with intimal microcalcification positivity alone (P = 0.012). The rate of renal graft function decline was significantly steeper in patients positive for intimal microcalcification than in patients who were negative (P = 0.036). In multivariate analysis, positivity for both intimal microcalcification and fetuin-A was an independent predictor for renal graft function decline (β = -10.21; P = 0.011). The intimal microcalcification was not associated with composite-event free survival.
  
  
  CONCLUSIONS
  Preexisting intimal microcalcification in the iliac artery predicts a lower allograft survival rate and rapid decline of allograft function. Positivity of fetuin-A with intimal microcalcification further reduces allograft survival rate and an independent predictor for renal graft function decline.
authors.affiliation: 1 Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea. 2 Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, Seoul, Korea. 3 Department of Pathology, The Catholic University of Korea, Seoul, Korea. 4 Department of Surgery, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hyeon Seok
authors.initials: HS
authors.lastname: Hwang
authors.forename: Sun Woo
authors.initials: SW
authors.lastname: Lim
authors.forename: In O
authors.initials: IO
authors.lastname: Sun
authors.forename: Keun Suk
authors.initials: KS
authors.lastname: Yang
authors.forename: Hye Eun
authors.initials: HE
authors.lastname: Yoon
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
authors.forename: Yeong Jin
authors.initials: YJ
authors.lastname: Choi
authors.forename: Ji Il
authors.initials: JI
authors.lastname: Kim
authors.forename: In
authors.initials: I
authors.lastname: Sung Moon
authors.forename: Suk Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000737:chemistry / Q000000981:diagnostic imaging; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011859:Radiography; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D017539:Tunica Intima / Q000737:chemistry / Q000000981:diagnostic imaging; D061205:Vascular Calcification / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D060749:alpha-2-HS-Glycoprotein / Q000032:analysis
chemical_list: C556354:AHSG protein, human; D015415:Biomarkers; D060749:alpha-2-HS-Glycoprotein