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Updated: Jun 25, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Post-Transplant Cardiovascular Disease in Kidney Transplant Recipients: Incidence, Risk Factors, and Outcomes in the
Chukwuma Austin Chukwu1,2, Anirudh Rao1,3, Rachel Middleton1,2
1Faculty of Biology, Medicine and Health, Division of Cardiovascular Medicine, The University of Manchester, Manchester M13 9PL, UK.
Insights
Post-transplant cardiovascular disease (PTCVD) affects kidney transplant recipients without prior heart issues. While not directly causing graft loss, PTCVD significantly increases recipient mortality, highlighting the need for better monitoring and care.
Area of Science:
- Nephrology and Transplant Medicine
- Cardiovascular Research
- Epidemiology
Background:
- Post-transplant cardiovascular disease (PTCVD) is a major complication in kidney transplant recipients (KTRs).
- Understanding PTCVD in KTRs without pre-existing cardiovascular disease (CVD) is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence of PTCVD in KTRs without prior CVD.
- To identify risk factors associated with PTCVD development.
- To evaluate the impact of PTCVD on graft survival and recipient mortality.
Main Methods:
- Retrospective analysis of 749 kidney transplant recipients without pre-existing CVD.
- Competing risk regression to identify PTCVD predictors.
- Cox proportional hazards analysis to assess PTCVD's impact on graft and recipient survival.
Main Results:
- Cumulative incidence of PTCVD reached 22.5% by 20 years post-transplant.
- Independent predictors for PTCVD included older age, longer dialysis duration, and declining estimated glomerular filtration rate (eGFR).
- PTCVD correlated with increased all-cause graft loss and significantly higher recipient mortality, but not death-censored graft loss.
Conclusions:
- Age, dialysis duration, and eGFR decline are key predictors of PTCVD in KTRs.
- PTCVD is a significant risk factor for mortality in kidney transplant recipients.
- Enhanced clinical management and surveillance are necessary for KTRs at risk of PTCVD.
Abstract:
Introduction: Post-transplant cardiovascular disease (PTCVD) poses a significant challenge in kidney transplantation, potentially impacting graft outcomes and patient survival. This retrospective study aimed to investigate the incidence, risk factors, and consequential impact of PTCVD in kidney transplant recipients (KTRs) devoid of pre-existing cardiovascular disease (CVD). Method: The cohort comprised 1114 KTRs, with 749 individuals included after excluding those with pre-existing CVD and early graft loss. PTCVD encompasses ischemic heart disease, myocardial infarction, arrhythmias, heart failure, stroke, peripheral vascular disease, and valvular heart disease. Competing risk regression analysis was performed to identify predictors of PTCVD, while Cox proportional hazards analysis assessed the impact of PTCVD on graft and recipient survival. Results: The cumulative incidence of PTCVD at 5, 10, and 20 years was 5.4%, 14.3%, and 22.5%, respectively. Competing risk regression identified increased age (sub-hazard ratio [SHR], 1.22; p = 0.036) per decade, duration of dialysis (SHR, 1.07; p = 0.048) per year on dialysis, and the slope of the estimated glomerular filtration rate (SHR, 1.08; p = 0.008) mL/min/year decline as independent predictors of higher-risk PTCVD. A higher baseline estimated glomerular filtration rate (eGFR) was protective (SHR, 0.98; p = 0.032). PTCVD was not significantly associated with death-censored graft loss (adjusted hazard ratio [aHR] 1.31; p = 0.48) but was correlated with higher all-cause graft loss (aHR, 1.71; p = 0.011) and recipient mortality (aHR, 1.97; p = 0.004). Conclusion: This study provides insights into PTCVD predictors. Although not directly associated with graft loss, PTCVD significantly correlates with heightened mortality in kidney transplant recipients, emphasizing the need for enhanced clinical management and surveillance strategies.
