Impact of Fractures on Death, Graft loss and Heart Failure After Living-Donor Kidney Transplantation

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https://storage.unitedwebnetwork.com/files/1099/645d9da783e5b65753ec3237f07521c4.pdf

Abstract Title *

Impact of Fractures on Death, Graft loss and Heart Failure After Living-Donor Kidney Transplantation

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Co-author 1

Yuki Shimamoto yukishimamot@gmail.com Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Transplant Surgery Nagoya Japan *

Co-author 2

Takahisa Hiramitsu thira@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Transplant Surgery Nagoya Japan -

Co-author 3

Manabu Okada ubanam@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Transplant Surgery Nagoya Japan -

Co-author 4

Kenta Futamura kenta88@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Transplant Surgery Nagoya Japan -

Co-author 5

Shunji Narumi nshunji@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Transplant Surgery Nagoya Japan -

Co-author 6

Yoshihiko Watarai watarai@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Transplant Surgery Nagoya Japan -

Co-author 7

Takaaki Kobayashi kobayashi.takaaki.925@mail.aichi-med-u.ac.jp Aichi Medical University Transplant Surgery Nagakute Japan -

Co-author 8

Co-author 9

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Co-author 11

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Introduction

Kidney transplant recipients (KTRs) are at high risk of osteoporosis and fractures because of immunosuppressants and chronic kidney disease-mineral bone disorder (CKD-MBD). Osteoporosis and fractures are reported to cause death or heart failure among general population. However, the impact of fractures on KTRs has not been fully elucidated.

Methods

This is a single-center, retrospective cohort study including 1262 living-donor KTRs between January 2008 and December 2021. The risk factor of major osteoporotic fracture (MOF) was investigated using multivariate Cox regression analysis. Death with functioning graft (DWFG), death-censored graft loss (DCGL), coronary artery disease (CAD), and Hospitalization for acute decompensated heart failure (HHF)-free survivals were compared in KTRs with and without MOF using time-dependent Cox proportional hazards models.

Results

MOF was identified in 151 recipients during median follow-up period of 88.7 months. Age, gender, history of MOF, and T-score before KT were significant risk factors. DWFG (hazard ratio (HR) 2.884, p<0.001), DCGL (HR 2.356, p=0.001 after 4.5 years), and HHF (HR 4.190, p<0.001) significantly increased following MOF, whereas CAD showed no difference. DCGL was caused by HHF more frequently in MOF group (34.6% vs 11.6%). Development of both MOF and HHF was associated with poorer DWFG and DCGL.

Conclusion

MOF and subsequent HHF can cause DWFG and DCGL in KTRs.

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