Original Article

Kidney International (2006) 70, 757–764. doi:10.1038/sj.ki.5001628; published online 21 June 2006

Cardiovascular events following renal transplantation: Role of traditional and transplant-specific risk factors

A M de Mattos1, J Prather1, A J Olyaei1, Y Shibagaki1, D S Keith2, M Mori3, D J Norman1 and T Becker3

  1. 1Transplantation Medicine Program, Oregon Health and Science University, Portland, Oregon, USA
  2. 2Department of Nephrology, McGill University Health Center, Royal Victoria Hospital, Montreal, Quebec, Canada
  3. 3Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, USA

Correspondence: AM de Mattos, University of Alabama at Birmingham, 1900 University Boulevard (THT647), Birmingham, Alabama 35294-0006, USA. E-mail: demattos@uab.edu

Received 28 November 2005; Revised 10 February 2006; Accepted 1 March 2006; Published online 21 June 2006.

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Abstract

Cardiovascular mortality is increased in transplant recipients. However, studies including non-fatal events are critical to assess the burden of disease and to identify novel risk factors. We described the incidence of fatal and non-fatal events, and explored associations and interactions among traditional and transplant-specific risk factors and cardiovascular events (CVE) in a cohort of 922 patients transplanted between 1993 and 1998. One hundred and seventy-six patients experienced 201 CVE (111 cardiac, 48 cerebrovascular, 42 peripheral-vascular). Most CVE were non-fatal. Factors associated with cardiac events were (adjusted hazard ratios) tobacco (3.53; P<0.001), obesity (2.92; P<0.001), diabetes (2.63; P<0.001), multiple rejections (2.19; P=0.008), prior CVE (2.0; P=0.004), dialysis >1 year (1.91; P=0.007), and overweight status (1.68; P=0.04); with cerebrovascular events: diabetes and peritoneal dialysis (11.95; P<0.001), age >45 (6.77; P<0.001), diabetes (4.87; P<0.001), prior CVE (3.73; P<0.001), creatinine >141 mumol/l (3.16; P=0.001), peritoneal dialysis (3.06; P=0.027), and obesity (0.32; P=0.046); with peripheral-vascular events: diabetes (8.48; P<0.001), tobacco and cytomegalovirus (3.88; P<0.001), age >45 (2.31; P=0.019), and prior CVE (2.25; P=0.016); with mortality: tobacco and deceased-donor (3.52; P<0.001), age >45 (1.81; P=0.002), diabetes (1.76; P=0.002), pulse pressure (1.64; P=0.029), prior CVE (1.52; P=0.04), and dialysis >1 year (1.47; P=0.04). The majority of CVE post-transplant were non-fatal. Previous CVE was strongly associated with CVE post-transplant. Interactions among transplant-specific and traditional risks impacted significantly the incidence of CVE. Modifiable factors such as duration of dialysis, deceased-donor transplantation, and acute rejection should be viewed as cardiovascular risks.

Keywords:

kidney transplantation, cardiovascular diseases, risk factors, cytomegalovirus

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