Renal transplant outcome in high-cardiovascular risk recipients (original) (raw)
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Detection and treatment of coronary artery disease in renal transplantation candidates
Transplantation Proceedings, 2002
D URING THE PAST three decades, despite the gradual but significant increase in the number of diabetics, elderly, and sick patients as renal transplant (Tx) recipients, the mortality rate following renal Tx has markedly decreased. Meanwhile, the main cause of death has changed from infection to cardiovascular disease (CVD). According to US Renal Data System, CVD is the most common cause of death in renal Tx recipients. 1 This finding is due to high prevalence of coronary artery disease (CAD) in this population. The risk is significantly higher among diabetic recipients. Reports from European Dialysis and Transplantation Association (EDTA) registry have also repeatedly emphasized the importance of CVD as the leading cause of death in both dialysis patients and renal Tx recipients, the incidence being higher than infectious causes. As almost all Tx recipients who die with CVD have a functioning graft, their death not only decreases the rate of patient survival but also graft survival. In a study from Scandinavia, Lindholm et al reported 49% graft loss due to patient death versus 41% due to rejection during the 2-to 5-year follow-up period of 1347 renal Tx recipients. 3 Fiftythree percent of deaths with a functioning graft were due to ischemic heart disease (IHD) and 10% due to other vascular events. Thus, more grafts were lost with patient mortality, secondary to cardiac death than due to graft rejection. So it is expected that in future further advances to increase long-term patient and graft survival rates will be dependent on prevention and treatment of CVD rather than on prevention and treatment of infections or immunosuppressive therapies. High prevalence of CAD (40%), left ventricular hypertrophy (LVH) (75%), and congestive heart failure (CHF) (40%) before Tx is the most important cause of increased cardiovascular mortality in renal Tx recipients. CAD and LVH are precursors of cardiovascular death and CHF is an independent predictor of cardiovascular mortality. 5 The traditional risk factors of CVD, such as hypertension, diabetes, hyperlipidemia, and hyperhomocysteinemia, are also very common before and after renal transplantation. Nonatherosclerotic cardiovascular structural changes specific to renal failure or uremic vasculopathy characterized by reduced capillary density, arteriolar wall thickening, and interstitial fibrosis of the heart has been shown in these patients. The high prevalence of traditional risk factors of CVD not only does not decrease after transplantation but also becomes exacerbated by immunosuppressive drugs, such as cyclosporine, tacrolimus, sirolimus, and steroids.
European Journal of Cardio-Thoracic Surgery, 2007
Background: Severe vascular disease is a relative contraindication to heart transplantation (HTx). We addressed the effect of vascular disease on HTx outcomes. Methods: This is a nonconcurrent cohort study of 402 patients who received HTx at our institution between 1985 and 2004. Pretransplant vascular evaluation included carotid, lower extremity, and renal artery duplex studies, and CT angiogram when indicated. Patients with severe and nontreatable vascular disease were excluded. Patients were divided into Group 1: those with pre-transplant vasculopathy, and Group 2: those without pre-transplant vasculopathy. Group 1 had 24 patients with 25 vascular lesions: 1 aortic dissection, 2 abdominal aortic aneurysm (AAA)'s, 5 carotid artery stenoses, 1 renal artery stenosis, and 16 peripheral vascular lesions. Interventions were performed to 15 lesions prior to HTx and to 2 lesions after HTx. Results: Median follow-up was 5.5 years. Group 1 had higher incidence of ischemic cardiomyopathy ( p < 0.001), hypertension ( p = 0.028), chronic obstructive pulmonary disease (COPD) ( p = 0.004), and smoking history ( p < 0.001). There were no differences in sex, hyperlipidemia, diabetes, stroke, or renal dysfunction. Multivariate analysis revealed odds of post-transplant death in Group 1 was 1.4 (95% CI: 0.48-4.1, p = 0.54) times greater than that in Group 2. Cox proportional hazards model for survival showed a 50% increase in the hazard of death in patients with pre-transplant vasculopathy, but without statistical significance. Group 1 had higher incidence of post-transplant stroke ( p = 0.001) but no difference in allograft coronary atherosclerosis. Conclusions: Pre-transplant vascular disease seems to have negative effect on outcomes after HTx. Larger scale study is needed for further evaluation. #
Transplantation, 2008
after additional adjustment for GFR, insulin, proteinuria, smoking, CRP, and medication. Our data show that RTR with MS have a two times higher risk for mortality. Moreover, our data suggest that MS constitutes more than the sum of its parts with regard to mortality. The risk is not conferred by impaired renal function, hyperinsulinemia, proteinuria, infl ammation, smoking, or medication.
Clinical and Experimental Nephrology, 2021
Background: The purpose of this study was to verify the risk factors present in patients on the kidney transplant waiting list that may interfere with the incidence of CV events and death during the first 12 months after transplantation. Methods: Based on data collected prospectively during pre-transplant workup, a retrospective study was conducted including 665 patients followed up until death or completing 12 months post-transplantation. Endpoints were the composite incidence of CV events and death. Results: The prevalence of diabetes, LV hypertrophy and CV disease at baseline was high; 14% of patients had angina, 26% an abnormal myocardial scan, and 47% coronary artery disease (CAD). CV events occurred in 53 patients (8.4%) and in 29 (55%) caused death. The independent predictors of events were age ≥ 50 years (HR: 2.292; CI%: 1.093-4.806), angina (HR: 1.969; CI%: 1.039-3.732), and altered myocardial scan (HR: 1.905, CI% 1.059-3.428). Altered myocardial scan (HR: 2.601; CI%: 1.129-5.988) was the sole predictor of CV death. Conclusion: The incidence of CV events and death were predicted by variables associated with myocardial ischemia. Patients with pre-transplantation myocardial ischemia should be considered at a higher risk of developing early CV complications and managed accordingly before, during, and after the operation.
Coronary Artery Disease Assessment and Intervention in Renal Transplant Patients
Transplantation, 2016
The authors declare no funding or conflicts of interest. J.J.G.D.L. conceived the investigation, analyzed the data, and wrote the article. L.H. W.G. analyzed the data and reviewed the article. F.J.d.P. reviewed the article. H.C.S. M. collected the data, revised charts, and analyzed the data. E.D.N. reviewed the article. L.A.B. reviewed the article.
Cardiovascular disease and kidney transplantation‑evaluation of potential transplant recipient
Polish Archives of Internal Medicine, 2014
Nowadays, from 50% to 60% of deaths can be directly attributed to CVD, with an incidence of ischemic heart disease being approximately 1 per 100 person-years at risk. 3 In contrast, some older studies reported that between 17% and 50% of deaths in kidney transplant recipients were due to CVD. 4 Moreover, CVD is the most common cause of death in kidney allograft recipients with a functioning graft, and accounts for 30% of overall graft loss from death, with the greatest rates in Cardiovascular disease and kidney disease Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients on renal replacement therapy, including kidney transplant recipients. 1 Death from CVD is also the most common cause of graft loss. 2 Mortality associated with kidney transplantation decreased significantly in the 1960s and 1980s owing to a reduction in the incidence of infection-related deaths, 2 while cardiovascular mortality increased.
Post-Transplant Cardiovascular Disease
Clinical Journal of the American Society of Nephrology, 2021
Cardiovascular disease remains a leading cause of death and morbidity in kidney transplant recipients and a common reason for post-transplant hospitalization. Several traditional and nontraditional cardiovascular risk factors exist, and many of them present pretransplant and worsened, in part, due to the addition of immunosuppression post-transplant. We discuss optimal strategies for identification and treatment of these risk factors, including the emerging role of sodium-glucose cotransporter 2 inhibitors in post-transplant diabetes and cardiovascular disease. We present common types of cardiovascular disease observed after kidney transplant, including coronary artery disease, heart failure, pulmonary hypertension, arrhythmia, and valvular disease. We also discuss screening, treatment, and prevention of post-transplant cardiac disease. We highlight areas of future research, including the need for goals and best medications for risk factors, the role of biomarkers, and the role of s...
Nephrology Dialysis Transplantation, 2022
BACKGROUND AND AIMS: Although improvement in histocompatibility matching, immunosuppressive therapy and antimicrobial treatment have led to improved longterm allograft survival, cardiovascular diseases (CVD) remain the major cause of morbidity and mortality in kidney transplant recipients (KTR). In addition to the accumulated risks due to chronic kidney disease and dialysis, kidney transplantation conveys its own unique risk factors for CVD. These include the metabolic effects of immunosuppressive treatments such as post-transplant hyperglycaemia, dyslipidaemia and hypertension as well as the effects of suboptimal kidney function including volume overload, anaemia, mineral bone disease and left ventricular hypertrophy. The predictors of cardiovascular diseases in KTR, however, have not been clearly defined. This study aimed to first ascertain the incidence of post-transplant CVD in those KTR without a prior confirmed history of CVD, then identify the predictors of CVD transplant associated CVD risk factors and finally evaluate the impact of CVD on graft and patient survival in this era of modern immunosuppressive medications. METHOD: We evaluated 962 KTR transplanted between 2000 and 2020 and followed in a single centre. About 328 KTR with a history of pre transplant CVD were excluded. CVD was defined as a composite of Ischaemic heart disease, myocardial infarction, heart failure, stroke or peripheral vascular disease. Logistic regression analyses were performed to identify the risk predictors of post-transplant CVD. Kaplan-Meier plots