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Kidney transplantation: is it a solution to endothelial dysfunction?

  • Nephrology - Review
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Abstract

Background

Endothelial dysfunction is associated with elevated cardiovascular risk in patients with end-stage renal disease (ESRD). Kidney transplantation has demonstrated significant ability in reducing mortality and improving quality of life in recipients. Recent studies have also reported improvements in endothelial function following kidney transplantation; however, current literature is limited.

Methods

We performed a systematic review of PubMed/Medline, Web of Science, Scopus, Cochrane Library, and CINAHL databases for prospective cohort studies that assessed endothelial function prior to and following kidney transplantation via various clinical markers. Follow-up duration ranged from 1 month to 1 year. A meta-analysis of pooled data was conducted using random-effect models for four key markers: brachial artery flow-mediated dilatation (FMD), high-sensitivity C-reactive protein (hsCRP), nitroglycerin-mediated dilation (NMD), and adiponectin.

Results

We included nine studies in our final analysis with a total of 524 patients. Significant improvement of all four biomarkers was observed after transplantation. The mean difference was 2.81% (95% CI 1.92–3.71, p < 0.00001) for FMD, 17.27 mg/L (95% CI 5.82–28.72, p = 0.003) for hsCRP, 1.05%, (95% CI 0.56–1.54, p < 0.0001) for NMD, and 9.27 µg/mL (95% CI 5.96–12.57, p < 0.00001) for adiponectin.

Conclusion

There is an immediate reversal of endothelial dysfunction in ESRD patients who undergo kidney transplantation, which may explain observed improvements in cardiovascular morbidity in transplant recipients. Future longitudinal studies are needed to understand possible re-emergence of endothelial dysfunction in the long-term postoperative period.

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Acknowledgements

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Funding

This study was not funded by any grant.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Section of Nephrology, Koc University School of Medicine, 34010, Istanbul, Turkey

    Mehmet Kanbay

  2. Cardiovascular Diseases Institute, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania

    Carina Ureche

  3. Department of Medicine, Koc University School of Medicine, Istanbul, Turkey

    Sidar Copur & Cem Tanriover

  4. Department of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania

    Alexandra M. Covic

  5. Vanderbilt University School of Medicine, Nashville, TN, USA

    Mert Sekmen

  6. Department of Nephrology, Grigore T. Popa’ University of Medicine, Iasi, Romania

    Adrian Covic

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  1. Mehmet Kanbay
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  2. Carina Ureche
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Contributions

Contributed substantially to the conception or design of the work: MK, SC, CU, AC. Contributed substantially to acquisition, analysis, or interpretation of data: CU, AC, MK. Drafted the manuscript: SC, MS, CT. Revision of the manuscript for important intellectual content: MK, AC, CU, AC, CT, SC.

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Correspondence to Mehmet Kanbay.

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Kanbay, M., Ureche, C., Copur, S. et al. Kidney transplantation: is it a solution to endothelial dysfunction?. Int Urol Nephrol 55, 1183–1191 (2023). https://doi.org/10.1007/s11255-022-03415-x

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