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Updated: May 9, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Risks of cardiovascular disease and cerebrovascular disease following kidney transplantation: A nationwide,
Tung-Han Tsai1, Kuang-Hua Huang1, Hsin Chen2,3
1Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan.
Insights
Kidney transplant recipients face higher risks of cardiovascular disease (CVD) and cerebrovascular disease (CBD). This risk increases significantly over time post-transplantation, highlighting a critical need for ongoing monitoring and research.
Area of Science:
- Nephrology and Transplant Medicine
- Cardiovascular Epidemiology
- Public Health Research
Background:
- Kidney transplant recipients (KTRs) exhibit elevated risks for cardiovascular disease (CVD) and cerebrovascular disease (CBD).
- Understanding these risks is crucial for post-transplant management and patient outcomes.
Purpose of the Study:
- To investigate the incidence and risks of CVD and CBD in kidney transplant recipients compared to non-recipients.
- To analyze the temporal trends of CVD and CBD risk following kidney transplantation.
Main Methods:
- Retrospective cohort study involving 3596 KTRs (2003-2017).
- Propensity Score Matching (PSM) used to create a control group of patients without kidney transplants.
- Cox proportional hazards models analyzed CVD and CBD risks at 6 months, 1, 3, and 5 years post-transplantation.
Main Results:
- KTRs demonstrated a significantly higher incidence rate of CVD (33.98 per 1,000 person-years) compared to controls.
- Adjusted hazard ratios indicated a 1.74-fold increased risk of CVD (aHR, 1.74; 95% CI, 1.58-1.93) and a 1.43-fold increased risk of CBD (aHR, 1.43; 95% CI, 1.23-1.68) in KTRs.
- CVD risk progressively increased over time, with the highest risk observed at the 5-year follow-up (aHR, 1.35; 95% CI, 1.17-1.56).
Conclusions:
- Kidney transplantation is associated with a significantly elevated risk of both cardiovascular and cerebrovascular diseases.
- The risk for these conditions escalates over time after kidney transplantation, necessitating long-term surveillance.
- Further large-scale, randomized controlled prospective studies are warranted to elucidate the causal relationship and optimal management strategies.
Abstract:
Background: Kidney transplant recipients (KTRs) have an increased risk for cardiovascular disease (CVD) and cerebrovascular disease (CBD). This study investigated the risks of CVD and CBD following kidney transplantation. Materials and methods: This retrospective cohort study enrolled 3596 KTRs between 2003 and 2017. Propensity Score Matching (PSM) was performed to select patients without a kidney transplant, who were assigned to the control group. Each KTR was matched with five patients without a kidney transplant by sex, age, insured salary, urbanization level, Charlson comorbidity index (CCI), and year of inclusion in the study. A Cox proportional hazards model was employed to investigate the risks of incident CVD and CBD in KTRs after adjusting for relevant variables. Furthermore, we analyzed for CVD and CBD risk 6 months and 1, 3, and 5 years after transplantation. Results: Among KTRs, the CVD incidence rate per 1,000 person-years was 33.98, which was significantly higher than that among patients without a kidney transplant. After adjusting for confounding variables, KTRs had a significantly higher risk of CVD (adjusted hazard ratio [aHR], 1.74; 95% confidence interval [CI], 1.58-1.93) than did patients without a kidney transplant. Regarding cumulative incidence, the risk of CVD increased over time. Among the four follow-up periods we assessed, the 5-year follow-up period had the highest CVD risk (aHR, 1.35; 95% CI, 1.17-1.56), followed by the 3-year follow-up period (aHR, 1.34; 95% CI, 1.13-1.59). KTRs also had a significantly higher risk of CBD (aHR, 1.43; 95% CI, 1.23-1.68) than did patients without a kidney transplant. Conclusion: CVD risk is higher among KTRs than among those without a kidney transplant, and this risk increases over time. CBD risk was also higher among KTRs. Large, randomized controlled prospective studies are needed to thoroughly evaluate the relationship between kidney transplantation and the risks of CVD and CBD.
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