title: Microvascular Disease After Renal Transplantation.
abstract: OBJECTIVE
  Individuals who reach end-stage kidney disease (CKD5) have a high risk of vascular events that persists even after renal transplantation. This study compared the prevalence and severity of microvascular disease in transplant recipients and patients with CKD5.
  
  
  METHODS
  Individuals with a renal transplant or CKD5 were recruited consecutively from renal clinics, and underwent bilateral retinal photography (Canon CR5-45, Canon). Their retinal images were deidentified and reviewed for hypertensive/microvascular signs by an ophthalmologist and a trained grader (Wong and Mitchell classification), and for vessel caliber at a grading centre using a computer-assisted method and Knudtson's modification of the Parr-Hubbard formula.
  
  
  RESULTS
  Ninety-two transplant recipients (median duration 6.4 years, range 0.8 to 28.8) and 70 subjects with CKD5 were studied. Transplant recipients were younger (p<0.001), with a higher eGFR (p< 0.001), but were just as likely to have a moderate-severe hypertensive/microvascular retinopathy (46/92, 50%) as subjects with CKD5 (38/70, 54%; OR 0.84, CI 0.45 to 1.57, p=0.64), and had similar mean arteriole and venular calibres (135.1 ± 7.5 µm and 137.9 ± 14.9 µm, p=0.12; and 199.1 ± 17.8 µm and 202.4 ± 27.8 µm, p=0.36, respectively). Arteriole and venular caliber were not different in nine patients examined before and after transplantation (p=0.62 and p=0.11, respectively).
  
  
  CONCLUSIONS
  Hypertensive/microvascular disease occurred just as often and was generally as severe in transplant recipients and subjects with CKD5. Microvascular disease potentially contributes to increased cardiac events post-transplantation.
authors.affiliation: The University of Melbourne, Department of Medicine (Northern Health), Epping, Australia.
authors.forename: Qi Lun
authors.initials: QL
authors.lastname: Ooi
authors.forename: Foong Kien Newk-Fon Hey
authors.initials: FK
authors.lastname: Tow
authors.forename: Raj
authors.initials: R
authors.lastname: Deva
authors.forename: Ryo
authors.initials: R
authors.lastname: Kawasaki
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.forename: Deb
authors.initials: D
authors.lastname: Colville
authors.forename: Francesco
authors.initials: F
authors.lastname: Ierino
authors.forename: Anastasia
authors.initials: A
authors.lastname: Hutchinson
authors.forename: Judy
authors.initials: J
authors.lastname: Savige
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001160:Arterioles / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D058437:Hypertensive Retinopathy / Q000453:epidemiology / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012160:Retina / Q000473:pathology; D012164:Retinal Diseases / Q000453:epidemiology / Q000209:etiology; D012171:Retinal Vessels / Q000473:pathology; D014652:Vascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D014699:Venules / Q000473:pathology; D055815:Young Adult