Renal transplantation in the modern immunosuppressive era in Spain: four-year results from a multicenter database focus on post-transplant cardiovascular disease.
To evaluate cardiovascular disease (CVD) after renal transplantation we established a CVD database (no-intervention) including all patients transplanted among 2000-2002 in 14 hospitals from Spain (Renal Forum Group) (n=2600). They were prospective followed annually thereafter and we present herein the most important results concerning survival figures and CVD at four years. Mean recipient age was 49.7+/-13.7 years: 16% retransplanted and 12.5% hyperimmunized. Tacrolimus, mycophenolate mofetil, and steroids was used in 63%. Acute rejection (AR) rate at 1 year was 14.8%. Graft and patient survival at 48 months were 85.6% (death censored) and 91.7% respectively. The first cause of graft loss was vascular in the first year, death with function during the 2-3 years, and chronic allograft nephropathy at the 4th year. Donor age, time on dialysis, acute tubular necrosis (ATN), AR, SCr at 6 months, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in the first year, and systolic blood pressure at 24 months were independent risk factors for graft loss at 4th year. The first cause of death was CVD (predominantly ischemic heart disease (IHD) in the first year). Recipient age, ATN, and SCr at 6 months were independent predictors of mortality. Despite worsening of donor age, comorbidity, and advanced age of recipients, survival figures at four years are considered good in our Spanish non-selected population. Cardiovascular mortality is the most important cause of death and graft loss particularly, IHD in the first year. Therefore, to decrease post-transplant mortality a careful cardiovascular evaluation and treatment in the waiting list and a close follow-up of patients after transplantation is mandatory.
Morales
Jose M
JM
Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain. jmorales@h12o.es
Marcén
Roberto
R
Andrés
Amado
A
Molina
Miguel González
MG
Castillo
Domingo Del
DD
Cabello
Mercedes
M
Capdevila
Luis
L
Campistol
Josep M
JM
Oppenheimer
Federico
F
Serón
Daniel
D
Vernet
Salvador Gil
SG
Lampreave
Ildefonso
I
Valdés
Francisco
F
Anaya
Fernando
F
Escuín
Fernando
F
Arias
Manuel
M
Pallardó
Luis
L
Bustamante
Jesús
J
D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus