Associations between pre-kidney-transplant risk factors and post-transplant cardiovascular events and death.
The prevalence of cardiovascular risk factors in renal transplant candidates is high. A better understanding of the relation between these risk factors and cardiovascular morbidity and mortality is mandatory to improve transplantation outcome. In this retrospective cohort study 2187 adult patients who received a first kidney transplant between 1984 and 1997 were included. We analyzed the incidence of post-transplant cardiovascular events and tried to identify independent pretransplant risk factors for post-transplant cardiovascular events and all-cause mortality. The cumulative incidence of post-transplant cardiovascular events was 40%. The incidence was highest in the first 3 months after transplantation. Independent pretransplant risk factors for a post-transplant cardiovascular event were diabetic nephropathy [Hazard ratio (HR) 3.02; 95% CI 2.85-3.98], claudication [HR 2.17 (1.42-3.31)], cardiac event [HR 1.76 (1.32-2.33)], cerebrovascular accident HR 1.53 (1.03-2.28), time-on-dialysis [HR 1.06 (1.02-1.11)], recipient age [HR 1.04 (1.04-1.05)], and body mass index [HR 1.03 (1.00-1.05)]. Diabetic nephropathy and cardiovascular disease were also important predictors for all-cause mortality. Diabetic nephropathy and cardiovascular disease were the most important predictors for cardiovascular events and all-cause mortality after renal transplantation. Early treatment of cardiovascular risk factors and pretransplant cardiovascular evaluation might improve transplantation outcome.
Department of Nephrology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. j.aalten@nier.umcn.nl
Jeroen
J
Aalten
Ellen K
EK
Hoogeveen
Joke I
JI
Roodnat
Willem
W
Weimar
George F
GF
Borm
Johan W
JW
de Fijter
Andries J
AJ
Hoitsma
D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends