title: Cardiovascular risk in recipients with kidney transplants from expanded criteria donors.
abstract: BACKGROUND
  Posttransplant cardiovascular disease (CVD) is the leading cause of death in renal transplant (RT) recipients and is more evident in recipients with transplants from expanded criteria donors (ECD).
  
  
  OBJECTIVE
  We analyzed the evolution of cardiovascular risk factors and their association with patient mortality.
  
  
  METHODS
  We undertook a single-center, prospective study of RT patients (n = 360) between 1999 and 2006. These were 180 recipients with transplants from ECD and 180 controls. We analyzed the baseline characteristics and the cardiovascular risk factors: hypertension, diabetes, dyslipidemia, CVD, and anemia. Posttransplant analyses included the evolution of cardiovascular risk factors and causes of death.
  
  
  RESULTS
  The mean age of the ECD was 63.5 ± 5.4 versus 32.0 ± 13.2 years in the non-ECD (P < .001) and the recipient ages were 58.4 ± 8.7 versus 40.8 ± 13.3 years, respectively (P < .001). The median interquartile range [IQR] dialysis time was 25 months (15-39) versus 20 months (12-44; P = .017). The pretransplant body mass index was 26.89 ± 3.91 versus 25.43 ± 4.72 kg/m(2) (P = .002); the median (IQR) number of antihypertensive drugs was two (1-2) versus two (1-2.75; P = .015); dyslipidemia was present in 32.5% versus 21.6% (P = .024), diabetes in 10.6% versus 5.6% (P = .087), and CVD in 13.3% versus 7.8% (P = .086). Treatment with erythropoiesis-stimulating agents (ESA) was received by 84.9% versus 83.9% (P = .857). Concerning transplantation, the mean follow-up was 64.3 ± 33.7 months. Hypertension was present at 3 and 5 years in 85.6% versus 69.5% (P = .001) and 87.9% versus 72.8% (P = .009), respiratory. Treatment with angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers at 3 and 5 years was 79.8% versus 64.5% and 85.6% versus 65%. Dyslipidemia was present at 5 years in 63.1% versus 58.0% (P = .482). De novo diabetes occurred in 16.7% versus 11.1% (P = .128), and CVD in 13.5% versus 4.5% (P = .003). Univariate and multivariate Cox regression proportional hazards models were constructed to analyze the factors associated with patient death.
  
  
  CONCLUSIONS
  CVD is the most common cause of death in recipients of ECD, RT, 40% in the ECD group versus 28.6% in the control group. Tight control of cardiovascular risk factors and a good pretransplant patient selection contributed to the good results obtained.
authors.affiliation: Nephrology and Pathology Departments, H.U. Carlos Haya, Malaga, Spain. lblancama@hotmail.com
authors.forename: L
authors.initials: L
authors.lastname: Blanca
authors.forename: T
authors.initials: T
authors.lastname: Jiménez
authors.forename: M
authors.initials: M
authors.lastname: Cabello
authors.forename: E
authors.initials: E
authors.lastname: Sola
authors.forename: C
authors.initials: C
authors.lastname: Gutierrez
authors.forename: D
authors.initials: D
authors.lastname: Burgos
authors.forename: V
authors.initials: V
authors.lastname: Lopez
authors.forename: D
authors.initials: D
authors.lastname: Hernandez
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D016022:Case-Control Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D046148:Donor Selection; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D055815:Young Adult