title: Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation.
abstract: BACKGROUND
  Malnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate in patients with end-stage renal disease. However, the clinical relevance of MIA syndrome in kidney transplantation (KT) recipients remains unknown.
  
  
  METHODS
  We enrolled 1348 adult KT recipients. Recipients were assessed based on serum albumin, cholesterol, or body mass index for the malnutrition factor and C-reactive protein level for the inflammation factor. Any history of cardiovascular (CV), cerebrovascular, or peripheral vascular disease satisfied the atherosclerosis factor. Each MIA factors were assessed by univariate analysis and we calculated an overall risk score by summing up scores for each independent variable. The enrolled patients were divided into 4 groups depending on the MIA score (0, 2-4, 6, 8-10).
  
  
  RESULTS
  The patients with higher MIA score showed worse outcome of fatal/non-fatal acute coronary syndrome (ACS) (p < 0.001) and composite outcomes of ACS and all-cause mortality (p < 0.001) than with the lower MIA score. In multivariate analysis, ACS showed significantly higher incidence in the MIA score 8-10 group than in the MIA score 0 group (Hazard ratio 6.12 95 % Confidence interval 1.84-20.32 p = 0.003).
  
  
  CONCLUSIONS
  The presence of MIA factors before KT is an independent predictor of post-transplant CV outcomes.
authors.affiliation: Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea. dennyjinho@gmail.com.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea. bboddo5@hanmail.net.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Ryu
authors.affiliation: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. lovingjn@gmail.com.
authors.forename: Jung Nam
authors.initials: JN
authors.lastname: An
authors.affiliation: Graduate School of Public Health, Seoul National University, Seoul, South Korea. hellotammy@snu.ac.kr.
authors.forename: Clara Tammy
authors.initials: CT
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea. mateus111@daum.net.
authors.forename: Hyosang
authors.initials: H
authors.lastname: Kim
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, South Korea. jcyjs@dreamwiz.com.
authors.forename: Jaeseok
authors.initials: J
authors.lastname: Yang
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, South Korea. jwhamd@snu.ac.kr.
authors.forename: Jongwon
authors.initials: J
authors.lastname: Ha
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. cdw1302@snubh.org.
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Chae
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, South Korea. curie@snu.ac.kr.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. curie@snu.ac.kr.
authors.forename: Curie
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea. imjung@brm.co.kr.
authors.forename: In Mok
authors.initials: IM
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. yoonkyuoh@gmail.com.
authors.forename: Yun Kyu
authors.initials: YK
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. cslimjy@snu.ac.kr.
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Lim
authors.affiliation: Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea. djhan@amc.seoul.kr.
authors.forename: Duck-Jong
authors.initials: DJ
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea. skpark@amc.seoul.kr.
authors.forename: Su-Kil
authors.initials: SK
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. yonsukim@snu.ac.kr.
authors.forename: Yon Su
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea. kyh-001@hanmail.net.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. nephrolee@gmail.com.
authors.forename: Jung Pyo
authors.initials: JP
authors.lastname: Lee
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000401:mortality; D002784:Cholesterol / Q000378:metabolism; D015897:Comorbidity; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology* / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000378:metabolism; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000401:mortality; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein; D002784:Cholesterol