Cardiovascular disease after renal transplantation

Abstract

Cardiovascular disease is a major hazard limiting the life expectancy of renal transplant recipients and the most frequent cause of late allograft loss. Patients with renal disease have usually been exposed for both traditional, and for them unique, risk factors over a prolonged period of time and may carry the burden of advanced atherosclerotic disease already at the time of transplantation. The observed survival benefit of transplantation is probably from elimination of the numerous uremia-related risk factors. However, immunosuppressive therapy and the chronic inflammatory state, together with genetic susceptibility and not infrequently impaired renal function, may bring about new potentially atherogenic conditions. Metabolic risk factors may jeopardize both patient and graft survival. Several observational studies provide evidence for the negative impact of preexisting metabolic abnormalities on long-term outcomes. Identification of modifiable cardiovascular risk factors may enable risk reduction also in renal transplant recipients. Results of ongoing intervention trials are awaited. The observed improvement of patient survival after renal transplantation during the past decade may reflect the increasing awareness and more optimal care of patients throughout the course of renal disease.

Predictive value of myocardial and coronary imaging in the long-term outcome of potential renal transplant recipients

“…This is in keeping with previous reports in patients with ESRD [18,19]. Mortality was lower in patients receiving a renal transplant, likely reasons for this being selection bias (less CAD patients in this group) and the acknowledged beneficial effects of renal transplantation on the cardiovascular outcomes of patients with ESRD [20]. However, all patients included in this study were to be considered for transplantation; whether the patients were then referred for transplantation after investigations were at the treating physicians' discretion.…”

Life expectancy and cause of death in males and females with Fabry disease: Findings from the Fabry Registry

“…28,29 Furthermore, it has been well established that patients who receive kidney transplants or hemodialysis are at increased risk of cardiovascular disease. 30,31 Consequently, the cardiovascular and renal manifestations of Fabry disease may be at least partially interrelated. The impact and pathophysiology of Fabry disease is well known and has been the focus of many studies.…”

Kidney Disease as a Risk Factor for Development of Cardiovascular Disease

“…CVD accounts for 35% to 50% of all-cause mortality in kidney transplant recipients, [75][76][77] and CVD mortality rates are at least twice as high as in an age-stratified sample of the general population but significantly lower than an agestratified dialysis population (Figure 1). 6,77 The 2 most likely explanations for the reduced risk in kidney transplant recipients compared with dialysis patients are selection bias for those undergoing transplantation and removal of the hemodynamic and uremic abnormalities associated with dialysis in those who receive transplants.…”