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Published on: April 12, 2021
Cardiac Events After Kidney Transplantation According to Pretransplantation Coronary Artery Disease and Coronary
R Felix1, T Saparia1, R Hirose2
1Cardiology and Nephrology Departments, Kaiser San Francisco Medical Center, San Francisco, California.
Insights
Cardiovascular events are common after kidney transplants, especially in patients with pre-existing coronary artery disease (CAD). Early prevention strategies for CAD are crucial for this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Science
Background:
- Cardiovascular disease is a leading cause of mortality in renal transplant recipients.
- Pre-transplantation coronary artery disease (CAD) is a significant risk factor for adverse outcomes post-transplant.
Purpose of the Study:
- To compare cardiovascular event rates in renal transplant recipients based on pre-transplantation CAD and revascularization.
- To characterize coronary angiographic findings in patients experiencing post-transplantation cardiovascular events.
Main Methods:
- Retrospective cohort study including 403 patients undergoing coronary angiography within 2 years pre-kidney transplantation.
- Evaluated pre-transplantation CAD and revascularization status as predictor variables.
- Primary outcome: composite of cardiovascular mortality, acute coronary syndrome, and post-transplantation revascularization.
Main Results:
- 73% of patients had pre-transplantation CAD; 22% underwent revascularization.
- 5.6-year follow-up revealed primary outcome rates of 5% (no CAD), 23% (CAD, no revascularization), and 26% (CAD with revascularization).
- CAD significantly increased the risk of cardiovascular events (HR, 4.39; P = .002).
Conclusions:
- Adverse cardiovascular outcomes are frequent following renal transplantation.
- Pre-transplantation CAD, regardless of severity, is strongly associated with post-transplant cardiovascular events.
- Prioritizing secondary prevention of CAD is essential for managing this high-risk patient group.
Objectives:
The aims of this study were to compare the rates of cardiovascular events among renal transplant recipients according to pre-transplantation coronary artery disease (CAD) and revascularization status and to describe the coronary angiographic findings in patients with post-transplantation events.
Methods:
This was a retrospective cohort study of patients who had coronary angiography within 2 years before kidney transplantation. The predictor variables were pre-transplantation CAD and coronary revascularization. The primary outcome was a composite of cardiovascular mortality, acute coronary syndrome, and post-transplantation revascularization.
Results:
The study included 403 patients. Pre-transplantation CAD was present in 73%, and 22% were revascularized. During a follow-up period of 5.6 years, the primary outcome occurred in 5% of the subjects without CAD, in 23% of those with CAD and no revascularization, and in 26% of those with CAD and revascularization (CAD hazard ratio [HR], 4.39 [P = .002]; revascularization HR, 1.27 [P = .36]). Thirty-five patients had a primary outcome and repeated coronary angiography, which demonstrated progression of previously nonsevere disease in the majority of cases.
Conclusions:
Adverse cardiovascular outcomes are common after renal transplantation and are associated with pre-transplantation CAD of any severity. Secondary prevention of CAD events should be a high priority in the management of this high-risk population.
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