title: Risk factors and outcome of stroke in renal transplant recipients.
abstract: Stroke incidence is high in end-stage renal disease, and risk factors differ between the dialysis and general populations. However, risk factors and outcomes following renal transplantation remain unclear. We analyzed all adult patients with a functioning renal transplant from 01/01/2007 to 12/31/2012. Data were extracted from the electronic patient record. Variables associated with stroke were identified by survival analyses; demographic, clinical, and imaging and laboratory variables were assessed and case fatality determined. Follow-up was until 05/12/2013. A total of 956 patients were identified (median age 40.1 years, 59.9% male). Atrial fibrillation (AF) prevalence was 9.2%, and 38.2% received a transplant during follow-up. A total of 26 (2.7%) experienced a stroke during 4409 patient-years of follow-up (84.6% ischemic). Stroke incidence was 5.96/1000 patient-years. Factors associated with stroke on regression analysis were prior stroke, diabetes, age, systolic hypertension, and hemoglobin. Atrial fibrillation was associated with time to stroke (P<0.001). Warfarin did not associate with ischemic stroke risk in those with AF. Fatality was 19.2% at 7, 23.1% at 28, and 42.3% at 365 days after stroke. Patients with a functioning renal transplant have a high stroke incidence and case fatality. Unlike those on hemodialysis, risk factors are similar to the general population. We did not demonstrate benefit from warfarin use in those with AF.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.|The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Findlay
authors.affiliation: The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Thomson
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: MacIsaac
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.|The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Jardine
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.|The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Rajan K
authors.initials: RK
authors.lastname: Patel
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.|The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Stevens
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.|The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Rutherford
authors.affiliation: The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Clancy
authors.affiliation: The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Colin C
authors.initials: CC
authors.lastname: Geddes
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Jesse
authors.initials: J
authors.lastname: Dawson
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.|The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Mark
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology
keywords: atrial fibrillation; cerebrovascular disease; renal transplant; stroke