Transplantology

Chronic kidney disease (CKD) remains one of the most frequent long-term complications following liver transplantation, with calcineurin inhibitor nephrotoxicity as an important and modifiable driver [...]

Background: Arterial stiffness assessed by measuring pulse wave velocity (PWV) is a well-established predictor of cardiovascular mortality. To our knowledge, no studies on arterial stiffness in kidney transplant recipients (KTRs) from Tunisia have been conducted. The present study aimed to assess arterial stiffness in Tunisian KTRs and to identify the key predictors associated with its increase. Methods: We conducted a cross-sectional, single-center study enrolling Tunisian KTRs aged 18 years or older with a minimum post-transplant follow-up of six months. Arterial stiffness was measured as pulse carotid–femoral PWV (CF-PWV) by a Complior device. A CF-PWV ≥ 10 m/s was defined as elevated. Results: Fifty-four KTRs were included (mean age: 42.55 ± 10.61 years). Among them, 19 (35.2%) had a CF-PWV ≥ 10 m/s. The univariate analysis showed a significant association between elevated CF-PWV and the following parameters: age, hypertension prior to transplantation, dyslipidemia, donor age, parameters obtained through office blood pressure measurement (systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP)), central SBP recorded by the Complior device, nocturnal SBP obtained through 24 h ambulatory blood pressure monitoring (ABPM), and fasting blood glucose. A multivariable analysis with CF-PWV ≥ 10 m/s as a dependent variable retained the following independent factors: dyslipidemia (p = 0.015; OR = 60.32), donor age (p = 0.014; OR = 1.16), SBP obtained through office blood pressure measurement (p = 0.015; OR = 1.25), and fasting blood glucose (p = 0.034; OR = 22.35). Conclusions: Given the major impact of cardiovascular disease on post-transplant outcomes, understanding the determinants of arterial stiffness is crucial for improving patient care. Routine PWV assessment may not be feasible in all centers due to cost or limited equipment availability. Therefore, identifying the clinical and biological markers associated with arterial stiffness offers a low-cost and widely accessible alternative for evaluating cardiovascular risk. These findings may support the development of a simple risk score to help nephrologists detect and manage high-risk KTRs more effectively.

Background: Post-transplant diabetes mellitus (PTDM) is a complication of kidney transplantation, but the impact of early hyperglycemia (EH) remains unclear. This study aimed to assess the incidence of PTDM in kidney transplant recipients (KTRs) who experienced EH compared to those who do not at 6 months post-transplant. Methods: A single-center, retrospective cohort study was conducted in adults who underwent kidney transplantation from 1 January 2019 to 25 May 2022. KTRs who developed EH were compared against those who did not. Results: The primary outcome was the difference in incidence of PTDM at 6 months. Secondary outcomes included rehospitalizations and infections within 6 months and PTDM, renal function, cardiovascular events, and graft and patient survival within 12 months. Two hundred and seventy-nine KTRs (EH, n = 204 vs. comparator, n = 75) were included. There were higher incidences of PTDM in the EH group compared to the comparator group at 6 months (11% vs. 1.4%, p = 0.012) and 12 months post-transplant (18.5% vs. 5.5%, p = 0.007). KTRs with EH had 8.9 times greater odds of developing PTDM (OR 8.9; 95% 1.2–67.3, p = 0.03) at 6 months. There was no significant difference found in other secondary outcomes. Conclusions: KTRs with EH had an increased incidence of developing PTDM.