title: Renal transplantation in high cardiovascular risk patients.
abstract: Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. The concept of high-risk patient has changed since the first stages of transplantation. In the first studies, the high-risk concept was based on probability of early graft failure or on a patient's clinical condition to cope with high perioperatory morbimortality. Later on, this concept implied immunological factors that were crucial to ensure transplant success because hypersensitized or polytransfused patients experienced a higher risk of acute rejection and subsequent graft loss. Afterward, the presence of various comorbidities would redefine the high-risk concept for renal transplant mainly considering recipient's clinical aspects. Currently, the change in epidemiological characteristics of patients starting dialysis causes that we now deal with a greater increase of elderly patients, diabetic patients, and patients with history of cardiovascular disease. Today, high-risk patients are those with clinical features that predict an increase in the risk of perioperative morbimortality or death with functioning graft. In this review, we will attempted to analyze currents results of renal transplant outcomes in terms of patients and graft survival in elderly patients, diabetic patients, and patients with previous cardiovascular disease from the most recent experiences in the literature and from experiences in our center. In any of the groups previously analyzed, survival offered by renal transplant is significantly higher compared to dialysis. Besides, these patients are the recipient group that benefit the most with the transplant because their mortality while remaining on dialysis is extremely high. Hence, renal transplantation should be offered more frequently to older patients, diabetic patients, and patients with pretransplant cardiac and peripheral vascular disease. A positive attitude toward renal transplantation is needed by physicians taking care of these patients from predialysis stages of chronic renal failure.
authors.affiliation: Renal Transplant Program, Hospital Privado- Centro Médico de Córdoba, 5016 Córdoba, Argentina.
authors.forename: Julio
authors.initials: J
authors.lastname: Bittar
authors.forename: Paula
authors.initials: P
authors.lastname: Arenas
authors.forename: Carlos
authors.initials: C
authors.lastname: Chiurchiu
authors.forename: Jorge
authors.initials: J
authors.lastname: de la Fuente
authors.forename: Javier
authors.initials: J
authors.lastname: de Arteaga
authors.forename: Walter
authors.initials: W
authors.lastname: Douthat
authors.forename: Pablo U
authors.initials: PU
authors.lastname: Massari
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D003925:Diabetic Angiopathies / Q000401:mortality; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors