Application of a Novel CT-Based Iliac Artery Calcification Scoring System for Predicting Renal Transplant Outcomes
Application of a Novel CT-Based Iliac Artery Calcification Scoring System for Predicting Renal Transplant Outcomes
复制标题
DOI：
10.2214/ajr.15.14794
复制
发表时间：
2016-02-01
影响因子：
5
通讯作者：
Kim, Charles Y.
中科院分区：
文献类型：
--
作者：
Davis, Bradley;Marin, Daniele;Kim, Charles Y.
OBJECTIVE.我们研究的目的是评估髂动脉钙化的程度和分布是否与肾移植后的结果相关，由CT为基础的钙评分系统确定。对术前2年内接受骨盆CT检查的肾移植受者进行回顾性分析，共纳入131例患者：75例男性和56例女性，平均年龄52岁。三名放射科医生对髂总动脉和髂外动脉的钙化长度、周向受累和形态进行了单独的半定量评分。对手术和临床记录进行了审查，以确定哪个髂动脉节段用于吻合、手术的复杂性以及是否发生移植物功能延迟恢复（DGF）。采用Kaplan-Meier技术计算移植肾存活率和患者存活率。观察者间对每个钙化评分类别的一致性极佳。对于所有类别，髂总动脉的平均钙化评分均显著高于髂外动脉。高龄和糖尿病是每一类别中较高得分的独立预测因素，而高血压、吸烟、高脂血症和性别则不是。基于多变量分析，仅用于吻合的动脉段的钙化形态评分独立预测较高的手术复杂性和DGF发生率。这些评分均不能预测移植物或患者存活率。然而，有髂动脉钙化CT证据的患者移植后1年生存率低于无钙化者（分别为92%和98%; p = 0.05）。只有用于吻合的动脉段的钙化形态评分可显著预测手术复杂性和DGF。在高龄或糖尿病患者中，常规移植前CT钙化评分可以选择最佳吻合动脉，以优化结局。
OBJECTIVE. The objective of our study was to assess whether the degree and distribution of iliac artery calcifications as determined by a CT-based calcium scoring system correlates with outcomes after renal transplant.MATERIALS AND METHODS. A retrospective review of renal transplant recipients who underwent CT of the pelvis within 2 years before surgery yielded 131 patients: 75 men and 56 women with a mean age of 52 years. Three radiologists assigned a separate semiquantitative score for calcification length, circumferential involvement, and morphology for the common iliac arteries and for the external iliac arteries. The operative and clinical notes were reviewed to determine which iliac arterial segment was used for anastomosis, the complexity of the operation, and whether delayed graft function (DGF) occurred. Renal allograft survival and patient survival were calculated using the Kaplan-Meier technique.RESULTS. Excellent interobserver agreement was noted for each calcification score category. The common iliac arteries showed significantly higher average calcification scores than the external iliac arteries for all categories. Advanced age and diabetes mellitus were independently predictive of higher scores in each category, whereas hypertension, cigarette smoking, hyperlipidemia, and sex were not. Based on multivariate analysis, only the calcification morphology score of the arterial segment used for anastomosis was independently predictive of a higher rate of surgical complexity and of DGF. None of the scores was predictive of graft or patient survival. However, patients with CT evidence of iliac arterial calcification had a lower 1-year survival after transplant than those who did not (92% vs 98%, respectively; p = 0.05).CONCLUSION. Only the calcification morphology score of the arterial segment used for anastomosis was significantly predictive of surgical complexity and of DGF. Routine pretransplant CT for calcification scoring in patients of advanced age or those with diabetes mellitus may enable selection of the optimal artery for anastomosis to optimize outcomes.