Stroke in renal transplant recipients: epidemiology, predictive risk factors and outcome

Oliveras, Anna; Roquer, Jaume; Puig, Josep; Rodríguez, Ana; Mir, Marisa; Orfila, María; Masramon, J.; Lloveras, J

doi:10.1034/j.1399-0012.2003.02042.x

Cited by 88 publications

(60 citation statements)

References 22 publications

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“…5 Similarly, several prior studies have described associations between hypertension and the development of CVD in kidney transplant recipients. 4,[32][33][34] Our findings reinforce these conclusions in a population with detailed ascertainment of CVD, further demonstrating that there is no notable J-shaped association between systolic BP level and cardiovascular or mortality outcomes. This study has several limitations.…”

Section: Discussionsupporting

confidence: 78%

BP, Cardiovascular Disease, and Death in the Folic Acid for Vascular Outcome Reduction in Transplantation Trial

Carpenter

John

Weir

et al. 2014

Journal of the American Society of Nephrology

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The optimal BP level in kidney transplant recipients remains uncertain. This post hoc analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) trial cohort assessed associations of BP with a pooled cardiovascular disease (CVD) outcome and with all-cause mortality. In 3474 prevalent kidney transplant patients, mean age was 5269 years, 63% were men, 76% were white, 20% had a history of CVD, 40% had a history of diabetes mellitus, and the median time since transplant was 4.1 years (25th to 75th percentiles, 1.7-7.4); mean systolic BP was 136620 mmHg and mean diastolic BP was 79612 mmHg. There were 497 CVD events and 406 deaths. After adjustment for demographic and transplant characteristics and CVD risk factors, each 20-mmHg increase in baseline systolic BP associated with a 32% increase in subsequent CVD risk (hazard ratio [HR], 1.32; 95% confidence interval [95% CI], 1.19 to 1.46) and a 13% increase in mortality risk (HR, 1.13; 95% CI, 1.01 to 1.27). Similarly, after adjustment, at diastolic BP levels,70 mmHg, each 10-mmHg decrease in diastolic BP level associated with a 31% increase in CVD risk (HR, 1.31; 95% CI, 1.06 to 1.62) and a 31% increase in mortality risk (HR, 1.31; 95% CI, 1.03 to 1.66). However, at diastolic BP levels.70 mmHg, there was no significant relationship between diastolic BP and outcomes. Higher systolic BP strongly and independently associated with increased risk of CVD and allcause mortality, without evidence of a J shape, whereas only lower levels of diastolic BP associated with increased risk of CVD and death in this trial.

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Section: Discussionsupporting

confidence: 78%

BP, Cardiovascular Disease, and Death in the Folic Acid for Vascular Outcome Reduction in Transplantation Trial

Carpenter

John

Weir

et al. 2014

Journal of the American Society of Nephrology

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“…Observation time was censored at Vertebrobasilar syndrome 435. 8 Other specified transient cerebral ischemia 435. 9 Other nonspecified transient cerebral ischemia transplantation for incidence computations among transplant candidates; similarly, at-risk time was ended at graft failure for incidence computations among transplant recipients.…”

Section: Definitions Of Outcomes and Covariates Cve And At-risk Periodsmentioning

confidence: 99%

“…Counts of observed cases of CVE in published studies have ranged from 19 (4.7%) of 402 prevalent diagnoses in a cross-sectional study of Spanish transplant patients (8) to 48 and 54 events among variably followed cohorts of 922 and 675 American transplant recipients (9,10), respectively. With respect to CVE types, the study of prevalent CVE among Spanish recipients identified seven (37%) of 19 diagnoses as hemorrhagic, but published cohort studies after transplantation have either not included hemorrhagic events in the outcome definition (10) or not distinguished CVE types in results reporting (9).…”

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confidence: 99%

Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

Lentine

Rey

Kolli

et al. 2008

Clinical Journal of the American Society of Nephrology

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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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“…Oliveras and colleagues observed a 10-year incidence rate of stroke at 8.0% in their single-center analysis of 403 patients, with nearly a 50% mortality risk within 3 months after the stroke. 4 Aull-Watschinger and colleagues observed 54 strokes (and 10 transient ischemic attacks) among 1633 recipients transplanted between 1995 and 2005 (incidence, 3.9%), of which 19 were fatal. 5 De Mattos and colleagues observed 48 stroke-related events (39 strokes, 6 transient ischemic attacks, and 3 carotid endarterectomies) in a cohort of 922 kidney allograft recipients who received a transplant between 1993 and 1998 (incidence, 5.2%), with 17 stroke-related deaths.…”

Section: Introductionmentioning

confidence: 99%

“…Oliveras and colleagues observed a 10-year incidence rate of stroke at 8.0% in their single-center analysis of 403 patients, with nearly a 50% mortality risk within 3 months after the stroke. 4 Renal Data System, they found a 3-year incidence of de novo stroke at 6.8% (lower than estimates on the waiting list or after graft loss). To our knowledge, no other study has been conducted at a population level to evaluate the effect of stroke-related events (fatal and nonfatal) in the context of kidney transplant; this represents a major gap in the literature.…”

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confidence: 99%

Untitled

2016

Exp Clin Transplant

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Objectives: Stroke is a major cause of mortality in the general population but data regarding stroke-related hospitalization or mortality after a kidney transplant is limited. We determined risk for stroke-related episodes after a kidney transplant in a populationbased cohort study of 19 103 kidney allograft recipients in England between 2001 and 2012. Materials and Methods:The incidence of stroke-related events after a kidney transplant with pretransplant history of stroke, the incidence of stroke-related hospitalization or death among all kidney allograft recipients after a kidney transplant, and risk factors for stroke-related mortality after a kidney transplant were examined. Data were obtained from hospital episode statistics (an administrative data warehouse that contains admissions to all National Health Service hospitals in England) and is linked to the Office for National Statistics, which collects information on all registered deaths in England. Results: There were 782 nonfatal stroke-related hospitalizations and 113 stroke-related deaths (5.4% of total deaths) after a kidney transplant (median follow-up 4.4 y after a kidney transplant). Risk for allcause mortality was higher for those recipients with, compared to those without, a history of stroke (21.5% vs 10.8%; P < .001). However, risk for stroke-related mortality after a kidney transplant was no different. Kidney allograft recipients with nonfatal stroke episodes after a transplant were at a higher risk for allcause and stroke-related mortality. In a Cox regression model, pretransplant history of stroke was an independent risk factor for all-cause mortality, but not stroke-related mortality, while posttransplant hospitalization with nonfatal stroke was a risk factor for both. Conclusions: Fatal and nonfatal stroke-related events are common among kidney allograft recipients. Further research is warranted to allow better risk stratification and facilitate clinical trials for risk attenuation of stroke after a kidney transplant. Key words: Cerebrovascular accident, Death, Transplant IntroductionStroke, or cerebrovascular accidents, is one of the leading causes of mortality in the world, estimated to be the second leading cause of global death by the World Health Organization. 1 In 2010, the global absolute numbers of individuals developing their first stroke, surviving stroke, or having a stroke-related death were 16.9 million, 33.0 million, and 5.9 million, with 69% of events occurring in individuals aged greater than 65 years. 2 In addition, stroke-related disability represents a significant health burden, with disability-adjusted life years lost an estimated 102 million globally in 2010. 2 Although age-standardized rates of stroke-related mortality are decreasing worldwide, 2,3 absolute numbers are increasing and they represent a major public health burden.In the context of transplant, the effect of strokerelated morbidity or mortality after a transplant is unclear because of a lack of published data. Oliveras and colleagues observed a 10-...

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Stroke in renal transplant recipients: epidemiology, predictive risk factors and outcome

Cited by 88 publications

References 22 publications

BP, Cardiovascular Disease, and Death in the Folic Acid for Vascular Outcome Reduction in Transplantation Trial

BP, Cardiovascular Disease, and Death in the Folic Acid for Vascular Outcome Reduction in Transplantation Trial

Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

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