Introduction: Angiopoietin-like-2 (angptl2) is a secreted glycoprotein with homology to the angiopoietins. Through an autocrine/paracrine manner, it promotes endothelial dysfunction and atherosclerosis. Angptl2 is increased in chronic kidney disease (CKD), where the risk of cardiovascular disease (CVD) is amplified. The objectives of the present study were to 1) examine whether kidney transplantation (KTx) reduces angptl2 levels, 2) identify the determinants of angptl2 after KTx, 3) study the association of angptl2 with aortic stiffness and 4) assess the impact of angpl2 on mortality of KTx.

Methods: In 75 subjects undergoing KTx, we evaluated clinical, biochemical and aortic stiffness before and 3 months after KTx. Angptl2 levels were determined by Elisa. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (cf-PWV). Logistic and Cox regressions were used for data analysis.

Results: After 3 months of KTx, angptl2 levels decreased from 71 ng/mL (IQR: 53–95) to 11 ng/mL (IQR: 9–15) P<0.001). In multivariate analysis, age, CVD, lower renal function and mean blood pressure were independently associated with higher angptl2 levels. There was a positive relationship between cf-PWV and angptl2 after KTx (r=0.260 P=0.024). After a median follow-up of 89 months, 13 deaths occurred. The group with higher angptl2 levels had a higher mortality rate (HR= 0.249 95% CI: 0.068–0.912, P=0.036).

Conclusion: There is a significant reduction in serum angptl2 levels after KTx however, our data demonstrate that after KTx, there is a positive association between angptl2, aortic stiffness and mortality, suggesting that angptl2 may play a biological role in CKD- related CVD.