Aortoiliac calcification assessment via computed tomography in kidney transplantation: correlation with graft outcomes.

BACKGROUND: Kidney transplantation (KT) is the most effective treatment option for end-stage renal disease.Vascular calcification is common in this population. Yet its relationship with graft outcomes remains uncertain. We evaluated whether aortoiliac calcification quantified on pretransplant computed tomography (CT) is associated with short- and long-term graft outcomes. METHODS: This single-center retrospective study included adult KT recipients.Aortoiliac calcification score (AICS) was measured using an adapted Agatston method across the infrarenal aorta, ipsilateral common iliac, and external iliac artery on the operative side. Patients were grouped as no-AICS (AICS = 0) or, if AICS > 0, as low-AICS vs. high-AICS by median. Short-term outcomes were early graft failure, delayed graft function (DGF), and acute rejection; long-term outcomes included graft function decline, death with a functioning graft, death-censored graft failure, and overall graft failure. RESULTS: Of 106 recipients (mean age 41.5 ± 12.8 years; 58.5% male), 54.8% had no-AICS; among those with calcification (n = 48), median AICS was 324 (IQR 85.5-897.5). DGF occurred in 9 patients (8.5%) and was more frequent in the high-AICS group (20.8%) than in the no-AICS (3.4%) and low-AICS (8.3%) groups (p = 0.037). An exploratory multivariable model yielded an imprecise association between high AICS and DGF (adjusted OR 26.3, 95% CI 1.01-675.1; p = 0.048). Over a median follow-up of 538 days, AICS groups were not significantly associated with long-term graft outcomes. No significant associations were identified in multivariable models for these endpoints. CONCLUSIONS: Higher AICS quantified by adapted Agatston scoring was not associated with long term graft survival outcomes within the follow-up period. An exploratory association between high AICS and DGF was observed, but the limited number of events precludes conclusions regarding an independent effect.