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Updated: Sep 27, 2025
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Published on: April 13, 2021
De novo major cardiovascular events in kidney transplant recipients: a comparative matched cohort study
Ji Eun Kim1,2, Jina Park3, Sehoon Park4
1Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Insights
Kidney transplant recipients (KTRs) have significantly lower major adverse cardiovascular events (MACEs) than dialysis patients, with a similar risk to the general population (GP). However, MACEs in KTRs increase the risk of mortality.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular disease is a leading cause of death post-kidney transplantation (KT).
- Limited data exists on de novo major adverse cardiovascular events (MACEs) in kidney transplant recipients (KTRs) compared to dialysis patients and the general population (GP).
Purpose of the Study:
- To compare the risk of de novo MACEs in KTRs versus dialysis patients and GP controls.
- To investigate the association between de novo MACEs and outcomes like all-cause mortality and death-censored graft failure (DCGF) in KTRs.
Main Methods:
- A nationwide health insurance database in South Korea was used to identify KTRs.
- KTRs were 1:1 matched with dialysis and GP controls without prior MACE.
- De novo MACEs (myocardial infarction, coronary revascularization, ischemic stroke), all-cause mortality, and DCGF were primary and secondary endpoints.
Main Results:
- Over 4.7 years, KTRs (n=4156) had significantly lower MACE risk (3.7/1000 person-years) than dialysis controls (21.7/1000 person-years) (aHR 0.16).
- KTRs showed similar MACE risk (2.5/1000 person-years) to GP controls (aHR 0.81), irrespective of age, sex, or comorbidities.
- De novo MACEs in KTRs increased all-cause mortality risk but not DCGF.
Conclusions:
- De novo MACE risk is substantially lower in KTRs compared to dialysis patients and comparable to the general population.
- While cardiovascular risk is similar to the general population, MACE occurrence in KTRs elevates mortality risk.
Background:
Although cardiovascular disease is known to be one of the leading causes of death after kidney transplantation (KT), evidence on the risk difference of de novo major adverse cardiovascular events (MACEs) in kidney transplant recipients (KTRs) compared with that in dialysis patients or the general population (GP) remains rare.
Methods:
We identified KTRs using the nationwide health insurance database in South Korea and then 1:1 matched them with the dialysis and GP controls without a pre-existing MACE. The primary endpoint was defined as de novo MACEs consisting of myocardial infarction, coronary revascularization and ischemic stroke. The secondary endpoints were all-cause mortality and death-censored graft failure (DCGF) in KTRs.
Results:
We included 4156 individuals in each of the three groups and followed them up for 4.7 years. De novo MACEs occurred in 3.7, 21.7 and 2.5 individuals per 1000 person-years in the KTRs, dialysis controls and GP controls, respectively. KTRs showed a lower MACE risk {adjusted hazard ratio (aHR) 0.16 [95% confidence interval (CI) 0.12-0.20], P < .001} than dialysis controls, whereas a similar MACE risk to GP controls [aHR 0.81 (95% CI 0.52-1.27), P = .365]. In addition, KTRs showed a similar MACE risk compared with the GP group, regardless of age, sex and the presence of comorbidities, including hypertension, diabetes and dyslipidemia. Among KTRs, de novo MACEs were associated with an increased risk of all-cause mortality, but not with DCGF.
Conclusions:
De novo MACEs in KTRs were much lower than that in dialysis patients and had a similar risk to the GP, but once it occurred it caused elevated mortality risk in KTRs.
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