Cardiovascular Risk in Recipients With Kidney Transplants From Expanded Criteria Donors

Blanca, L.; Jiménez, Tamara; Cabello, M.D. Navarro; Sola, E.; Gutiérrez, Cristina; Burgos, D.; López, Verónica; Hernandez, Dena G.

doi:10.1016/j.transproceed.2012.09.086

Cited by 21 publications

(7 citation statements)

References 13 publications

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“…Recipients of poor-quality donor kidneys (extended criteria donors) are well known to have a higher incidence of hypertension post-transplant. 30 Acute Rejection and Chronic Allograft Injury Any cause of injury to the transplanted kidney can lead to de novo or worsening of post-transplant hypertension. Among the most common causes are acute rejection (cellular and antibody-mediated acute rejection) and chronic allograft injury (including chronic antibody-mediated rejection and interstitial fibrosis/tubular atrophy), thrombotic microangiopathy, and recurrent glomerular disease.…”

Section: Donor Factorsmentioning

confidence: 99%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

152

111

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Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drugdrug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.

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Section: Donor Factorsmentioning

confidence: 99%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

152

111

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“…The disparity between the number of patients awaiting kidney transplantation and the number of available donor kidneys continues to increase (1,2). To address this growing demand, expanded criteria donor (ECD) kidneys are increasingly being used (2,3); however, compared with recipients of non-ECD kidneys, those who receive ECD kidneys are at increased risk of graft failure and cardiovascular events and have worse renal function and decreased life expectancy (3)(4)(5)(6)(7)(8)(9)(10). Causes of graft lost include inherited donor lesions (11), the adverse effects of immunosuppression and antibody-mediated chronic rejection.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes in Belatacept- Versus Cyclosporine-Treated Recipients of Extended Criteria Donor Kidneys: Final Results From BENEFIT-EXT, a Phase III Randomized Study

Dürrbach

Pestana

Florman

et al. 2016

American Journal of Transplantation

129

123

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In the Belatacept Evaluation of Nephroprotection and Efficacy as First‐Line Immunosuppression Trial–Extended Criteria Donors (BENEFIT‐EXT), extended criteria donor kidney recipients were randomized to receive belatacept‐based (more intense [MI] or less intense [LI]) or cyclosporine‐based immunosuppression. In prior analyses, belatacept was associated with significantly better renal function compared with cyclosporine. In this prospective analysis of the intent‐to‐treat population, efficacy and safety were compared across regimens at 7 years after transplant. Overall, 128 of 184 belatacept MI–treated, 138 of 175 belatacept LI–treated and 108 of 184 cyclosporine‐treated patients contributed data to these analyses. Hazard ratios (HRs) comparing time to death or graft loss were 0.915 (95% confidence interval [CI] 0.625–1.339; p = 0.65) for belatacept MI versus cyclosporine and 0.927 (95% CI 0.634–1.356; p = 0.70) for belatacept LI versus cyclosporine. Mean estimated GFR (eGFR) plus or minus standard error at 7 years was 53.9 ± 1.9, 54.2 ± 1.9, and 35.3 ± 2.0 mL/min per 1.73 m2 for belatacept MI, belatacept LI and cyclosporine, respectively (p < 0.001 for overall treatment effect). HRs comparing freedom from death, graft loss or eGFR <20 mL/min per 1.73 m2 were 0.754 (95% CI 0.536–1.061; p = 0.10) for belatacept MI versus cyclosporine and 0.706 (95% CI 0.499–0.998; p = 0.05) for belatacept LI versus cyclosporine. Acute rejection rates and safety profiles of belatacept‐ and cyclosporine‐based treatment were similar. De novo donor‐specific antibody incidence was lower for belatacept (p ≤ 0.0001). Relative to cyclosporine, belatacept was associated with similar death and graft loss and improved renal function at 7 years after transplant and had a safety profile consistent with previous reports.

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“…Cardiovascular complications are still the leading cause affecting the longterm survival of RTRs after surgery. 34 There are multiple studies that suggest the association of pre-emptive CAG and intervention with low cardiac morbidity and mortality in CKD patients that subsequently got transplanted or are on the transplant waiting list. 7,35 Similarly, in a recent meta-analysis of 38 nonrandomized studies with 85,731 patients with CKD, a 27% lower mortality was observed with coronary revascularization when compared with no revascularization.…”

Section: Discussionmentioning

confidence: 99%

<p>Spectrum of Coronary Angiographic Findings in Potential Renal Transplant Recipients in a Tertiary Care Center of Nepal</p>

Yadav¹,

Jha²,

Gajurel³

et al. 2020

TRRM

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Background: Studies emphasizing the prevalence of coronary artery disease (CAD) and the diversity of coronary lesions among asymptomatic renal transplant recipients (RTRs) are few and far between in Nepal. Methods: In this cross-sectional observational study, a cohort of potential RTRs who were subjected to coronary angiography (CAG) as a part of both routine pre-op evaluation and therapeutic modality were enrolled and the spectrum of coronary angiographic lesions was reported. Significant CAD was defined by angiography as ≥70% stenosis. Percutaneous coronary intervention (PCI) was done for significant lesions. Results: A total of 60 patients (mean age: 53.7 ± 7.2 years, 43 males and 17 females) formed the subjects of the study. Diabetes was the commonest cause of ESRD (61.7%) with the mean duration of ESRD being 4.3 ± 2.2 years. Of the patients, 86.7% were routinely subjected to CAG and the remaining 13.3% presented with acute coronary syndrome. The right femoral artery was the most common access vessel (81.7%). CAD was present in 30/60 patients (50%). The left anterior descending artery was the most common culprit vessel (46.7%), followed by the left circumflex artery (38.3%). Among the routine CAG group, 42.3% had some form of CAD, the highest proportion of which was triple vessel disease (23.3%). Both double vessel disease and triple vessel disease were found to be highly prevalent in patients with hyperlipidemia, diabetes, and in smokers. The angiographic lesions were predominantly of discrete (41%), diffuse (35.9%), and eccentric (46.2%) types, had tandem arrangement (58.9%) with moderate angulation (56.4%), and were irregular (58.9%) in contour. A total of 3 ostial (7.7%) and 9 calcified (23.1%) lesions were found to be present. Chronic total occlusion and bifurcation lesions were observed in 4 (10.3%) and 5 (12.8%) cases, respectively. Six (15.4%) patients had well-developed collaterals. Twenty-one (53.8%) patients underwent PCI and 3 (7.7%) patients underwent coronary artery bypass surgery. Type B2 was the most common lesion (46.2%). Conclusion: Asymptomatic ESRD patients on the renal transplant list were found to have a high prevalence of CAD. CAG can be an efficient screening alternative for the detection of significant CAD among these patients.

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Cardiovascular Risk in Recipients With Kidney Transplants From Expanded Criteria Donors

Cited by 21 publications

References 13 publications

Assessment and Management of Hypertension in Transplant Patients

Assessment and Management of Hypertension in Transplant Patients

Long-Term Outcomes in Belatacept- Versus Cyclosporine-Treated Recipients of Extended Criteria Donor Kidneys: Final Results From BENEFIT-EXT, a Phase III Randomized Study

<p>Spectrum of Coronary Angiographic Findings in Potential Renal Transplant Recipients in a Tertiary Care Center of Nepal</p>

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