Cardiovascular manifestations of allograft dysfunction in renal transplant recipients: a review

Cardiovascular complications are the leading cause of death among renal transplant recipients; renal graft dysfunction has special effects on cardiovascular morbidity and mortality.

Several studies have demonstrated a significant correlation between creatinine level and major coronary events, congestive heart failure and cerebrovascular events. Cardiovascular mortality has been related in different reports to serum creatinine levels and duration on renal replacement therapy. A low estimated glomerular filtration rate (eGFR) was also found to be a significant predictor of death in the pediatric kidney transplant population. Immunosuppressive therapy is also associated with several adverse effects. It has been shown that earlier withdrawal of steroids is associated with less cardiovascular effects, especially via reduction in the incidence of hypertension, hyperlipidemia, weight gain, and post-transplant diabetes. The introduction of calcineurin inhibitors (CNIs) has led to an increase in the number of renal transplant patients dying with a functioning graft, mainly because of cardiovascular disease. Compared to CNIs, mycophenolate mofetil has been proposed to reduce infiltration of circulating lymphocytes to the atherosclerotic plaque. Sirolimus is known to be associated with higher incidence of hyperlipidemia and hyperglycemia but lower incidence of hypertension.

Dialysis duration, renal allograft dysfunction and the immunosuppressive agents used enhance cardiovascular risk among the renal transplantation population. Transplanted children are at a particularly high risk of cardiovascular events post-transplantation.