Cause of death with graft function among renal transplant recipients in an integrated healthcare system.
BACKGROUND
Cardiovascular disease (CVD) is the leading cause of death in renal transplant recipients with a functioning allograft. Modification of CVD risk factors may, therefore, decrease overall mortality in this patient population. We studied renal transplant recipients within an integrated healthcare system (IHS) that uses case management and electronic health records to determine mortality from CVD.


METHODS
We retrospectively collected data on all renal transplant recipients over a 10-year period. The primary endpoint was death with graft function (DWGF). Cardiovascular events were used as secondary endpoints. We determined the cause of death and collected laboratory data. The data were analyzed using Student's t test for continuous data, chi square for categorical data, and multivariate logistic regression. Survival was determined using the Kaplan-Meier product-limit method.


RESULTS
Death from "other" causes accounted for 29%. This was followed by CVD (24%), infection (16%), and malignancy (12%). The most common "other" causes were diabetes mellitus and end-stage renal disease. Overall, lower hemoglobin, uncontrolled blood pressure, and lower albumin levels were associated with DWGF. There were 184 cardiovascular events in total. Low-density lipid levels were lower in the group with cardiovascular events and DWGF. The use of antihypertensive and antihyperlipidemic agents was similar between the two groups with the exception of diuretics, which were used more often in the DWGF group.


CONCLUSIONS
There was a low rate of DWGF because of CVD within this IHS. It is possible that coordinated care within an IHS leads to improved cardiovascular mortality.
Kidney and Pancreas Transplant Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA. kahwajiJ@cshs.org
Joseph
J
Kahwaji
Suphamai
S
Bunnapradist
Jin-Wen
JW
Hsu
Mohammed L
ML
Idroos
Ryszard
R
Dudek
D002140:California / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006279:Health Maintenance Organizations; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies