Associations between pre-kidney-transplant risk factors and post-transplant cardiovascular events and death

Abstract

Summary The prevalence of cardiovascular risk factors in renal transplant candidates is high. A better understanding of the relation between these risk factors and cardiovascular morbidity and mortality is mandatory to improve transplantation outcome. In this retrospective cohort study 2187 adult patients who received a first kidney transplant between 1984 and 1997 were included. We analyzed the incidence of post‐transplant cardiovascular events and tried to identify independent pretransplant risk factors for post‐transplant cardiovascular events and all‐cause mortality. The cumulative incidence of post‐transplant cardiovascular events was 40%. The incidence was highest in the first 3 months after transplantation. Independent pretransplant risk factors for a post‐transplant cardiovascular event were diabetic nephropathy [Hazard ratio (HR) 3.02; 95% CI 2.85–3.98], claudication [HR 2.17 (1.42–3.31)], cardiac event [HR 1.76 (1.32–2.33)], cerebrovascular accident HR 1.53 (1.03–2.28), time‐on‐dialysis [HR 1.06 (1.02–1.11)], recipient age [HR 1.04 (1.04–1.05)], and body mass index [HR 1.03 (1.00–1.05)]. Diabetic nephropathy and cardiovascular disease were also important predictors for all‐cause mortality. Diabetic nephropathy and cardiovascular disease were the most important predictors for cardiovascular events and all‐cause mortality after renal transplantation. Early treatment of cardiovascular risk factors and pretransplant cardiovascular evaluation might improve transplantation outcome.

Proteomic profiling of renal allograft rejection in serum using magnetic bead–based sample fractionation and MALDI-TOF MS

“…Humoral immunity attacks allografts by producing specific antibodies against the grafts [20][21][22][23][24]. In addition, pre-existing conditions, such as diabetes mellitus, [25,26], hypertension [27,28], cardiovascular conditions [29,30], infections [31][32][33], malignancy [34][35][36], were all factors that affect the outcomes and survival of transplant grafts. Once a pathological process begins, renal allografts express and release protein molecules at different levels or patterns compared with their physiological conditions.…”

Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates

“…This distinction is important because perioperative risk stratification has traditionally focused on identifying patients with undiagnosed or unstable CAD as a way to reduce the risk of MACEs after surgery. In a retrospective study of 2187 transplant recipients, Aalten et al 84 reported independent associations of recipient age, diabetic nephropathy, claudication, and prior cardiac events with an increased risk of cardiac events (defined as MI, coronary revascularization, stroke, or cardiac death) within the first 3 months after kidney transplantation.…”

The Prevention and Treatment of Coronary Artery Disease in Kidney Transplant Recipients

“…The incidence of CVD amongst transplant recipients is estimated to be 4.7-40 % at 3 years post-transplant [ 15 , 16 ]. A long-term study of renal transplant recipients documented a 40 % cumulative incidence of CVD at 10 years post-transplant [ 17 ].…”