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Published on: April 12, 2021
Predicting coronary heart disease after kidney transplantation: Patient Outcomes in Renal Transplantation (PORT)
A K Israni1, J J Snyder, M A Skeans
1Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA.
Insights
Coronary heart disease (CHD) risk after kidney transplant is not fully explained by traditional factors. Transplant-related factors, especially graft function, are key predictors of CHD in these patients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Traditional risk factors inadequately predict coronary heart disease (CHD) risk post-kidney transplantation.
- A significant proportion of CHD risk in kidney transplant recipients remains unexplained by conventional metrics.
Purpose of the Study:
- To compare traditional and nontraditional CHD risk factors in kidney transplant recipients.
- To develop and validate risk-prediction equations for CHD in this population.
Main Methods:
- Retrospective analysis of a large, multicenter database of 23,575 adult kidney transplant patients.
- Cox proportional hazards analyses were used to identify CHD risk factors.
- Risk-prediction equations were developed and validated using time-dependent c-statistics.
Main Results:
- CHD cumulative incidence was 3.1% at 1 year, 5.2% at 3 years, and 7.6% at 5 years post-transplant.
- Key predictors included pre- and post-transplant diabetes, prior cardiovascular events, estimated glomerular filtration rate, delayed graft function, acute rejection, age, sex, race, and duration of end-stage kidney disease.
- Traditional risk factors like hypertension, dyslipidemia, and smoking provided minimal additional predictive value.
Conclusions:
- Transplant-related factors, particularly those associated with graft function, are crucial in explaining CHD risk after kidney transplantation.
- Developed risk-prediction equations demonstrated good performance (c-statistic > 0.75).
- Clinical practice should incorporate these transplant-specific factors for accurate CHD risk assessment.
Abstract:
Traditional risk factors do not adequately explain coronary heart disease (CHD) risk after kidney transplantation. We used a large, multicenter database to compare traditional and nontraditional CHD risk factors, and to develop risk-prediction equations for kidney transplant patients in standard clinical practice. We retrospectively assessed risk factors for CHD (acute myocardial infarction, coronary artery revascularization or sudden death) in 23,575 adult kidney transplant patients from 14 transplant centers worldwide. The CHD cumulative incidence was 3.1%, 5.2% and 7.6%, at 1, 3 and 5 years posttransplant, respectively. In separate Cox proportional hazards analyses of CHD in the first posttransplant year (predicted at time of transplant), and predicted within 3 years after a clinic visit occurring in posttransplant years 1-5, important risk factors included pretransplant diabetes, new onset posttransplant diabetes, prior pre- and posttransplant cardiovascular disease events, estimated glomerular filtration rate, delayed graft function, acute rejection, age, sex, race and duration of pretransplant end-stage kidney disease. The risk-prediction equations performed well, with the time-dependent c-statistic greater than 0.75. Traditional risk factors (e.g. hypertension, dyslipidemia and cigarette smoking) added little additional predictive value. Thus, transplant-related risk factors, particularly those linked to graft function, explain much of the variation in CHD after kidney transplantation.
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