[Cardiovascular disease after renal transplantation].
Cardiovascular disease is the leading cause of morbidity and mortality following renal transplantation. Because many renal transplant recipients die with functioning grafts, deaths resulting from cardiovascular disease have became an increasingly important cause of graft loss, particularly after the first post-transplantation year. Moreover, a contribution of some cardiovascular risk factors to renal allograft dysfunction has been demonstrated. A number of observational studies suggest that cardiovascular disease is more common in renal transplant patients than in the general population. The excessive risk for cardiovascular disease is related to a high prevalence and accumulation of atherogenic risk factors before and after transplantation. Hypertension, post-transplantation diabetes and hyperlipidemia are well-recognized risk factors for the development of cardiovascular events after renal transplantation and are strongly associated with immunosuppressive therapy. Progressive renal dysfunction may also influence the risk of cardiovascular complications after renal transplantation. The elevated risk may also be caused by non- traditional risk factors such as anaemia, adhesion molecules, hyperhomocysteinemia, microinflammatory state, abnormal coagulation and oxidative stress. To prevent post-transplantation cardiovascular disease it is crucial to define the etiological risk factors. Some risk factors can be modified, and for some of these, there is strong evidence from studies in the general population that intervention improves survival. Given the significant morbidity and mortality of cardiovascular disease in renal transplant recipients, aggressive treatment intervention for potentially modifiable factors are strongly advocated after transplantation. In addition to treatment intervention, risk management should also involve tailoring the immunosuppressive regimen to minimize both direct and indirect cardiovascular risks. In this article we attempted to review and quantify the post-transplant risk factors for cardiovascular disease as well as offer suggestions on optimizing the therapy or treatment strategies to minimize the risk of cardiovascular complications in renal transplant patients. Reduction of cardiovascular morbidity and mortality can improve not only the life expectancy and quality of life of the transplant recipients but also their graft function and survival.
Montanaro
D
D
Struttura Operativa Complessa di Nefrologia e Dialisi, Azienda Ospedaliera S. Maria della Misericordia, Udine. montanaro.domenico@aoud.sanita.fvg.it
Gropuzzo
M
M
Tulissi
P
P
Boscutti
G
G
Risaliti
A
A
Baccarani
U
U
Adani
G L
GL
Sainz
M
M
Bresadola
F
F
Mioni
G
G
D000740:Anemia / Q000150:complications; D001778:Blood Coagulation Disorders / Q000150:complications; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D048909:Diabetes Complications; D006084:Graft Rejection / Q000150:complications; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D016030:Kidney Transplantation / Q000009:adverse effects*; D009765:Obesity / Q000150:complications; D011086:Polycythemia / Q000150:complications; D011507:Proteinuria / Q000150:complications; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects