[Cardiovascular mortality in kidney transplatation]

The most relevant novelties in the area of cardiovascular disease in kidney transplant can be divided into various aspects. The most noteworthy findings with regard to pretransplant cardiovascular evaluation were that patients who had a cardiovascular event before transplant are at greater risk of cardiovascular morbidity and mortality posttransplant, the echocardiogram can predict kidney transplant patient survival better than coronary angiography, and the result of coronary angiography is not prognostic in diabetic patients. On the other hand, many of the published studies focused on obesity as a cardiovascular risk factor. Although some results are contradictory, it seems that obesity adversely affects graft and patient survival, especially in more extreme situations. Various studies have also been published that stress the high prevalence of prediabetes and diabetes in first year after transplant, with the consequent need to perform the oral glucose tolerance test in nondiabetic patients. With regard to intermediate markers of target-organ damage, the progressive importance of measuring carotid intima-media thickness and coronary calcifications in the follow-up of kidney transplant patients with high cardiovascular risk should be stressed. The most relevant novelties in the area of therapeutic interventions are those related to the effect of different immunosuppressants on cardiovascular risk factors and the effect of hypolidemic agents (statins, ezetimibe, fish oil) on the course of the kidney graft and kidney transplant patient.