title: Impact of homocysteinemia on long-term renal transplant survival.
abstract: OBJECTIVE
  We prospectively followed a cohort of 202 renal transplant recipients for 5 years to examine the impact of fasting homocysteinemia on long-term patient and renal allograft survival.
  
  
  METHODS
  Cox proportional hazards regression analysis was used to identify independent predictors of all-cause mortality and graft loss.
  
  
  RESULTS
  Hyperhomocysteinemia (tHcy >15 micromol/L) was present in 48.7% of the 202 patients, predominantly among men (55.8%) as opposed to women (37.1%). At the end of the follow-up period, 13 (6.4%) patients had died including 10 from cardiovascular disease, and 23 had (11.4%) had lost their grafts. Patient death with a functioning allograft was the most prevalent cause of graft loss (13 recipients). Levels of tHcy were higher among patients who died than among survivors (median 23.9 vs 14.3 micromol/L; P = .005). Median tHcy concentration was also higher among the patients who had lost their allografts than those who did not (median 19.0 vs 14.1 micromol/L; P = .001). In a Cox regression model including gender, serum creatinine concentration, transplant duration, traditional cardiovascular risk factors, and associated conditions, such as past cardiovascular disease, only tHcy concentration (ln) (HR = 5.50; 95% CI, 1.56 to 19.36; P = .008) and age at transplantation (HR = 1.07; 95% CI, 1.02 to 1.13; P = .01) were independent predictors of patient survival. After censoring data for patient death, tHcy concentration was not a risk factor for graft loss.
  
  
  CONCLUSIONS
  This prospective study shows that tHcy concentration is a significant predictor of mortality, but not of graft loss, after censoring data for patient death.
authors.affiliation: Department of Nephrology, Santo Antonio Hospital, Porto, Portugal. isabelfonseca@mail.telepac.pt
authors.forename: I
authors.initials: I
authors.lastname: Fonseca
authors.forename: L
authors.initials: L
authors.lastname: Martins
authors.forename: J
authors.initials: J
authors.lastname: Queirós
authors.forename: D
authors.initials: D
authors.lastname: Mendonça
authors.forename: L
authors.initials: L
authors.lastname: Dias
authors.forename: A M
authors.initials: AM
authors.lastname: Sarmento
authors.forename: A C
authors.initials: AC
authors.lastname: Henriques
authors.forename: A
authors.initials: A
authors.lastname: Cabrita
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology*; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors