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Updated: Jul 11, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Renal transplant outcome in high-cardiovascular risk recipients
Tarun K Jeloka1, Heather Ross, Robert Smith
1Renal Transplant Programme, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
Insights
High-CV risk renal transplant recipients with known coronary artery disease (CAD) have lower survival rates. While cardiac interventions may lower perioperative risk, they do not eliminate post-transplant cardiac events.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular disease is a leading cause of death and illness in renal transplant recipients.
- The prevalence of cardiovascular disease is expected to rise with the acceptance of older patients for transplantation.
- Outcomes for high-CV risk patients, particularly those with pre-existing coronary artery disease (CAD), post-renal transplantation are not well-documented.
Purpose of the Study:
- To investigate the cardiovascular outcomes in renal transplant recipients with known pre-transplant coronary artery disease (CAD).
- To compare post-transplant cardiac events and survival rates between high-risk and low-risk patient groups.
- To identify predictors of post-transplant cardiac events in renal transplant recipients.
Main Methods:
- A retrospective analysis of renal transplants performed between 1998 and 2002, with follow-up until 2005.
- Patients were stratified into high-risk (pre-transplant angina, myocardial infarction, or positive coronary angiogram) and low-risk groups.
- Cox-regression multivariate analysis was employed to determine predictors of post-transplant cardiac events.
Main Results:
- 10.5% of 429 patients experienced post-transplant cardiac events, with significantly higher rates in the high-risk group (31.3%) versus the low-risk group (6.5%).
- Five-year patient survival was lower in the high-risk group (82.8%) compared to the low-risk group (93.1%).
- Age, pre-transplant cardiac disease, arrhythmias, and low ejection fraction (<40%) were identified as independent predictors of post-transplant cardiac events.
Conclusions:
- Renal transplant recipients with known CAD (high-CV risk) exhibit reduced post-transplant survival compared to low-risk recipients, though survival remains acceptable.
- Pre-transplant cardiac interventions may mitigate perioperative risks but do not reduce the incidence of post-transplant cardiac events to levels seen in the low-risk group.
Background:
Cardiovascular (CV) disease is the foremost cause of mortality and an important cause of morbidity in renal transplant recipients. The disease burden is likely to increase as older patients are accepted for transplantation. The outcome of these high-CV risk patients after renal transplantation, especially with known pre-transplant coronary artery disease (CAD), has not been studied. Hence, we looked at the CV outcome in patients with known pre-transplant CAD.
Methods:
All renal transplants performed between 1998 and 2002 at our center, followed up to 2005, were divided into high- and low-risk groups, based on the presence of one or more of the following: pre-transplant angina, myocardial infarction, and positive coronary angiogram. The two groups were compared for post-transplant cardiac events and patient and graft survival. The factors predictive of post-transplant cardiac events were also determined by Cox-regression multivariate analysis.
Results:
Forty-five patients (10.5%), out of 429, had post-transplant cardiac events; 31.3% in the high risk, and 6.5% in the low-risk group (p = 0.001). Five-yr patient survival was lower in the high-risk group (82.8% vs. 93.1%, p = 0.004), while five-yr overall graft survival and death censored graft survival were statistically not different (74.8% vs. 84.1%, p = 0.08 and 87.3% vs. 90%, p = 0.25). Forty-one percent of patients who were treated with angioplasty plus stenting or bypass graft prior to transplantation had post-transplant cardiac events, as compared with 28% of those without intervention in the high-risk group and 6.5% of patients in the low-risk group (p = 0.001). Age, pre-transplant cardiac disease, arrhythmias, and low-ejection fraction (< or = 40%) were significant independent predictors of post-transplant cardiac events.
Conclusion:
Post-transplant survival of high-CV risk patients (with known CAD) is lower than that of low-risk recipients but remains acceptable. Cardiac interventions may reduce perioperative risk but do not reduce the probability of post-transplant cardiac events to that of low-risk group.
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