title: Stroke-Related Hospitalization and Mortality After a Kidney Allograft: A Population-Cohort Study.
abstract: OBJECTIVE
  Stroke is a major cause of mortality in the general population but data regarding stroke-related hospitalization or mortality after a kidney transplant is limited. We determined risk for stroke-related episodes after a kidney transplant in a population-based cohort study of 19,103 kidney allograft recipients in England between 2001 and 2012.
  
  
  METHODS
  The incidence of stroke-related events after a kidney transplant with pretransplant history of stroke, the incidence of stroke-related hospitalization or death among all kidney allograft recipients after a kidney transplant, and risk factors for stroke-related mortality after a kidney transplant were examined. Data were obtained from hospital episode statistics (an administrative data warehouse that contains admissions to all National Health Service hospitals in England) and is linked to the Office for National Statistics, which collects information on all registered deaths in England.
  
  
  RESULTS
  There were 782 nonfatal stroke-related hospitalizations and 113 stroke-related deaths (5.4% of total deaths) after a kidney transplant (median follow-up 4.4 y after a kidney transplant). Risk for all-cause mortality was higher for those recipients with, compared to those without, a history of stroke (21.5% vs 10.8%; P < .001). However, risk for stroke-related mortality after a kidney transplant was no different. Kidney allograft recipients with nonfatal stroke episodes after a transplant were at a higher risk for all-cause and stroke-related mortality. In a Cox regression model, pretransplant history of stroke was an independent risk factor for all-cause mortality, but not stroke-related mortality, while posttransplant hospitalization with nonfatal stroke was a risk factor for both.
  
  
  CONCLUSIONS
  Fatal and nonfatal stroke-related events are common among kidney allograft recipients. Further research is warranted to allow better risk stratification and facilitate clinical trials for risk attenuation of stroke after a kidney transplant.
authors: From the Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors: Charles J
authors: CJ
authors: Ferro
authors: Asra
authors: A
authors: Karim
authors: Daniela
authors: D
authors: Farrugia
authors: David
authors: D
authors: Bagnall
authors: Irena
authors: I
authors: Begaj
authors: Daniel
authors: D
authors: Ray
authors: Adnan
authors: A
authors: Sharif
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D016009:Chi-Square Distribution; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome