Incidence and risk factors for cardiovascular events and death in pediatric renal transplant patients: a single center long-term outcome study.
There are considerable mortality data associated with renal transplantation in children; however, morbidity data, especially related to CV disease, are scarce. The objectives of this study were to determine incidence of non-fatal and fatal CV events and all-cause mortality in PRTx and evaluate risk factors for these conditions. Using a population-based retrospective cohort design, 274 PRTx with or without a functioning graft was followed until death or date of last contact (median follow-up 11.9 yr). Primary outcomes (time to first fatal or non-fatal CV event and all-cause mortality after first transplant) were ascertained from chart review and linkage with administrative databases of a universal health care system. During 3073 patient-years, there were 46 deaths; 13 were because of CV disease. Twenty patients had CV events that did not result in death. Post-transplant diabetes mellitus (10.5%) was associated with increased risk of death (HR: 2.79, 95% CI: 1.04-7.44) and CV events (HR: 3.90, 95% CI: 1.31-11.59). Low estimated glomerular filtration rate at one yr post-transplant was also associated with increased risk of death. The rates of developing CV disease and dying prematurely are extraordinarily high in PRTx, underscoring the need for early and aggressive intervention to reduce the burden of suffering in this patient population.
Koshy
Susan M
SM
Division of Nephrology, Department of Pediatrics, SickKids Hospital, Toronto, ON, Canada. susan.koshy@albertahealthservices.ca
Guttmann
Astrid
A
Hebert
Diane
D
Parkes
Robert K
RK
Logan
Alexander G
AG
D000293:Adolescent; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D002648:Child; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate