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Sex Differences in Subclinical Cardiovascular Organ Damage After Renal Transplantation: A Single-Center Cohort Study
Tabea Stocklassa1, Bianca Borchert-Mörlins1, Nima Memaran1
1Department of Pediatric Kidney, Liver and Metabolic Diseases, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
Insights
Cardiovascular disease risk differs by sex after kidney transplants. Women experienced increased heart muscle mass, but calcium channel blockers (CCBs) improved outcomes, particularly for female recipients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular disease (CVD) is a primary cause of mortality post-renal transplantation (RT).
- Sex-specific variations in CVD are established in the general population.
- Subclinical cardiovascular (CV) organ damage requires investigation in RT recipients.
Purpose of the Study:
- To investigate sex-specific differences in the prevalence and progression of subclinical CV organ damage.
- To evaluate these differences within the first year following renal transplantation.
Main Methods:
- Prospective longitudinal study of 121 renal transplant recipients (64% male, mean age 51 years).
- Assessment of CV risk factors, left ventricular mass index (LVMI), and pulse wave velocity (PWV) at RT and 1 year post-RT.
- Multivariable analysis to identify independent predictors of LVMI changes.
Main Results:
- Women presented with less pre-existing CVD and better blood pressure (BP) control, with lower use of calcium channel blockers (CCBs).
- Despite comparable graft function, LVMI increased in women and decreased in men (p=0.027).
- Female sex and systolic BP were independently associated with LVMI changes.
- Women on CCBs demonstrated reduced LVMI and PWV.
Conclusions:
- Renal transplantation is associated with sex-specific changes in left ventricular mass.
- Calcium channel blockers may mitigate CV risk post-RT, especially in female recipients.
- Further research into sex-based effects and CCB utilization in RT patients is warranted.
Abstract:
Cardiovascular disease (CVD) is the leading cause of death after renal transplantation (RT). Sex-specific differences in CVD in the general population are well known. The aim of this study was to evaluate sex-specific differences in prevalence and course of subclinical cardiovascular (CV) organ damage in RT recipients during the first year after RT. In a prospective longitudinal study, we enrolled 121 patients (male 64%, age 51 ± 15 years). CV risk factors, left ventricular mass index (LVMI), and pulse wave velocity (PWV) were assessed at time of RT and 1 year later. Women showed less prediagnosed CVD and better blood pressure (BP) control, and were less likely to be treated with calcium channel blockers (CCBs). Despite similar transplant function, LVMI increased in women and decreased in men (p = 0.027). In multivariable analysis, changes in LVMI were independently associated with female sex and systolic BP. Importantly, women receiving CCBs showed a decrease in LVMI and PWV. Our findings indicate a sex-specific association between RT and changes in LVMI. CCBs seem to have a positive impact on CV risk after RT, especially in women. Further studies on the effect of sex and CCB use in RT recipients are warranted.
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