Background The cardiac implications of obesity in kidney transplant recipients are not well-described. Methods We examined associations of body mass index (BMI) at transplant with post-transplant cardiac risk among 1,102 renal allograft recipients at a single center in 1991-2004. Cumulative post-transplant incidences of congestive heart failure (CHF), atrial fibrillation (AF), myocardial infarction (MI), and a composite of these cardiac diagnoses were estimated by the Kaplan-Meier method. Bivariate (hazards ratio, HR) and covariate-adjusted (aHR) relationships of BMI increments with cardiac risk were modeled by Cox's regression. We also systematically reviewed the literature on BMI and cardiac events after transplant. Results In the local data, 5-year cumulative incidence of any cardiac diagnosis rose from 8.67% to 29.35% across the lowest to highest BMI quartiles (P=0.02), driven primarily by increases in CHF and AF. In contrast, the rate of MI did not differ by BMI quartile (P=0.56). Each 5 U BMI increase predicted 26 % higher risk of the cardiac composite (HR 1.26, 95% CI 1.06 −1.48 2.14, P=0.008), a relationship that persisted with significance after covariate adjustment (aHR 1.19, 95% CI 1.00 −1.43, P=0.049). BMI independently predicted cardiac risk in sub-cohorts with pre-transplant heart disease and with non-diabetic renal failure. Data from 26 original articles support BMI as a risk factor for post-transplant CHF and AF, whereas findings for coronary/ischemic outcomes are inconsistent and predominantly negative. Conclusions High BMI at transplant predicts increased cardiac risk, especially of CHF and AF. Further research should examine whether obesity treatment modifies cardiac risk after kidney transplantation.

Background and objectives: This study examined the risks, predictors, and mortality implications of cerebrovascular disease events after kidney transplantation in a national cohort.Design, setting, participants, & measurements: This analysis used United States Renal Data System registry data to study retrospectively Medicare-insured kidney transplant candidates (n ‫؍‬ 51,504), recipients (n ‫؍‬ 29,614), and recipients with allograft failure (n ‫؍‬ 2954) in 1995 through 2002. New-onset cerebrovascular disease events including ischemic stroke, hemorrhagic stroke, and transient ischemic attacks were ascertained from billing records, and participants were followed until Medicare-end or December 31, 2002. Multivariable survival analysis was used to compare cerebrovascular disease event incidence and risk profiles among the study samples.Results: The cumulative, 3-yr incidence of de novo cerebrovascular disease events after transplantation was 6.8% and was lower than adjusted 3-yr estimates of 11.8% on the waiting list and 11.2% after graft loss. In time-dependent regression, transplantation predicted a 34% reduction in subsequent, overall cerebrovascular disease events risk compared with remaining on the waiting list, whereas risk for cerebrovascular disease events increased >150% after graft failure. Similar relationships with transplantation and graft loss were observed for each type of cerebrovascular disease event. Smoking was a potentially preventable correlate of posttransplantation cerebrovascular disease events. Women were not protected. All forms of cerebrovascular disease event diagnoses after transplantation predicted increased mortality.Conclusions: Along with known benefits for cardiac complications, transplantation with sustained graft function seems to reduce risk for vascular disease events involving the cerebral circulation.

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Introduction: We report our experience with seven cases of combined heart-kidney transplantation (HKT). Patients and methods: Between January 2003 and December 2009, seven subjects underwent combined HKT, receiving both organs from a single donor. Their age ranged from 30 years to 59 years, six were male. Five patients were dialysis dependent before transplantation and two were in chronic renal failure (serum creatinine levels > 2.6 mg/dL). The heart was transplanted first in all cases. Results: Heart function rapidly re-covered in five of the patients, while two needed temporary inotropic and mechanical support. Diuresis started immediately in four patients. At discharge, all patients had well-functioning grafts (left ventricular ejection fraction 60% ± 6%; serum creatinine 1.4 ± 0.3 mg/dL). After an average follow-up period of 45 ± 24 months no deaths have occurred. Heart allografts are functioning normally in six patients and none of the patients currently require dialysis treatment. The main adverse event noted during follow-up was hypertension in five patients. Four patients were cardiac allograft rejection free and five patients were kidney rejection free. Conclusion: Our results are in line with the data which has been previously reported in the literature and suggest that HKT is a viable therapeutic choice in the treatment of advanced cardiac and renal failure in carefully selected patients.