5.3 REVERSIBILITY OF ARTERIAL STIFFNESS AFTER KIDNEY TRANSPLANTATION: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Chronic kidney disease is associated with increased arterial stiffness. Correction of the uremic milieu by kidney transplantation (KTx) may be improve arterial stiffness. However, results from clinical studies are not uniformly convincing. This could be related to small sample size of studies, heterogeneity in methods and timing of assessment of arterial stiffness after KTx. We aim to measure the reversibility of arterial stiffness after KTx. Design and Method: Observational studies and randomized controlled trials with measurements of pulse wave velocity (PWV), pulse pressure (PP) and/or augmentation index (AIx) were extracted from MEDLINE, EMBASE, COCHRANE LIBRARY, and Web of Science from their inception to January 2016. Two reviewers independently identified eligible studies comparing PW, PP and/or AIx pre to post KTx and extracted data including population characteristics, interventions and outcomes. Results: 13 studies of 981 met our inclusion criteria. 11 Studies (408 renal transplant) have been included in meta-analysis. There was a standard mean change of PWV by −0.45 (95% CI: − 0.68 −0.20, I2=58%) post-KTx. Both studies using aortic PWV (5 studies, 160 patients) and those using brachial-ankle PWV, showed a significant decrease of PWV by −1.58 m/s (95% CI: −2.97 − 0.19, I2= 87%) and by −1.21 m/s (95% CI: − 1.89 – 0.54, I2=0 %) post-KTx, respectively. Analysis of central PP and AIx showed significant reduction post-KTx by −4.77 (95% CI: −9.19 −0.35, I2=55%) and by −11.59 (95% CI:-15.64 −7.53, I2=43%), respectively. Only two studies have reported adjusted parameters for mean arterial pressure. Conclusions: There is a significant reduction in PWV, central PP and AIx after KTx. Heterogeneity among studies are globally moderate. Further analysis is required to examine the importance of changes in different vascular beds taking into account changes in blood pressure.