Predicting coronary heart disease after kidney transplantation: Patient Outcomes in Renal Transplantation (PORT) Study.
Traditional risk factors do not adequately explain coronary heart disease (CHD) risk after kidney transplantation. We used a large, multicenter database to compare traditional and nontraditional CHD risk factors, and to develop risk-prediction equations for kidney transplant patients in standard clinical practice. We retrospectively assessed risk factors for CHD (acute myocardial infarction, coronary artery revascularization or sudden death) in 23,575 adult kidney transplant patients from 14 transplant centers worldwide. The CHD cumulative incidence was 3.1%, 5.2% and 7.6%, at 1, 3 and 5 years posttransplant, respectively. In separate Cox proportional hazards analyses of CHD in the first posttransplant year (predicted at time of transplant), and predicted within 3 years after a clinic visit occurring in posttransplant years 1-5, important risk factors included pretransplant diabetes, new onset posttransplant diabetes, prior pre- and posttransplant cardiovascular disease events, estimated glomerular filtration rate, delayed graft function, acute rejection, age, sex, race and duration of pretransplant end-stage kidney disease. The risk-prediction equations performed well, with the time-dependent c-statistic greater than 0.75. Traditional risk factors (e.g. hypertension, dyslipidemia and cigarette smoking) added little additional predictive value. Thus, transplant-related risk factors, particularly those linked to graft function, explain much of the variation in CHD after kidney transplantation.
Israni
A K
AK
Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA.
Snyder
J J
JJ
Skeans
M A
MA
Peng
Y
Y
Maclean
J R
JR
Weinhandl
E D
ED
Kasiske
B L
BL
D000328:Adult; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000150:complications / Q000209:etiology; D003327:Coronary Disease / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000150:complications / Q000209:etiology; D015994:Incidence; D007668:Kidney; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000150:complications / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D017063:Outcome Assessment, Health Care; D012307:Risk Factors