Mitral annular calcification (MAC) is a chronic degenerative process increasing with age and is considered as a risk factor for cardiovascular events and deaths. Prevalence of MAC is higher in patients with end stage disease.

The aim of this study was to assess if presence of MAC remains a risk factors in a population of kidney transplant recipient (KTR).

Between February 2004 and January 2005, all the RTR followed in our institution a complete 2D echocardiography and a vascular scanner. All the echos were reanalysed for MAC. MAC extent and distribution were graded semiquantitatively (0=no calcification, 4 severe calcification) using 2D echocardiography. Demographic and clinical characteristics (biological data, data related to renal failure and transplant) were extracted from the medical file. Follow-up data was obtained.

From the 300 RTR, echodata could be analysed for 279 RTR, mean age 52±13years (168 (80% males), dialysis time before renal transplant (RT): 2,3±2,3 y, time after RT 7,6±8,3y). Mean creat: 1,6±0,8mg/dl. During a mean follow-up of 11±3 years, 114(48%) patients died. Because survival was related to time after RT, we divided our population in 3 groups:<5years, 5–10 years and>10 years after RT. In Cox multivariate analysis adjusted for time after RT, survival was significantly related to: age (P=0.027), ejection fraction (P<0.005), posterior wall thickness (P=0.005), MAC score (P=0.021), aorta scanner calcification score (P<0.001) (Fig. 1). According to the 5 covariates, we could propose a risk score for prediction of survival in RTR: Risk Score RTR=0,64 (log10[Ao+1])–0,04 EF+0,05 PWD+0,3 Mitral calc score+0,04 age (EF: ejection fraction, PWD: posterior wall thickness).

In RTR, MAC are an important risk factor for mortality specially in the first years after RT. This emphasizes the importance of the control of cardiovascular risk factor in this population.