Variations in the risk for cerebrovascular events after kidney transplant compared with experience on the waiting list and after graft failure.
OBJECTIVE
This study examined the risks, predictors, and mortality implications of cerebrovascular disease events after kidney transplantation in a national cohort.


METHODS
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.
Lentine
Krista L
KL
St. Louis University Center for Outcomes Research, Salus Center 2nd Floor, 3545 Lafayette Avenue, St. Louis, MO 63104, USA. lentine.krista@stanfordalumni.org.
Rocca Rey
Lisa A
LA
Kolli
Swathy
S
Bacchi
Giuliana
G
Schnitzler
Mark A
MA
Abbott
Kevin C
KC
Xiao
Huiling
H
Brennan
Daniel C
DC
D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D002546:Ischemic Attack, Transient / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists