Cardiovascular Disease Management Consensus in Kidney Transplantation Recipients

Kidney transplantation is the definitive treatment for end-stage kidney disease; however, organ availability in Taiwan remains limited, with only 4.9% of patients on the waiting list receiving transplants in 2019. More than 86,000 individuals require regular dialysis, highlighting the need for improved transplantation rates. Although the median survival time post-transplantation is 5.7 years, nearly half of Taiwanese transplant recipients died in 2019, emphasizing cardiovascular disease as a major concern. Notably, patients who survive for more than a decade post-transplantation are increasingly prone to cardiovascular disease, diabetes, and hypertension. The aim of this study was to develop a joint consensus with the Taiwan Society of Nephrology, Taiwan Society of Cardiology, and Transplantation Society of Taiwan, to outline the best practices for evaluating and managing cardiovascular disease in kidney transplant recipients.

A consensus committee of 24 Taiwanese nephrologists, cardiologists, and surgeons synthesized recommendations from the literature and international guidelines, finalizing them via a formal voting process (70%/90% agreement).

Clinical recommendations emphasize pre-transplant cardiac assessment, including echocardiography and perfusion imaging; vigilant post-transplant surveillance of blood pressure, lipids, and glycemic control; and the judicious use of immunosuppressants to minimize metabolic complications. Multidisciplinary collaboration between nephrologists, cardiologists, and transplant experts is crucial for delivering patient-centered care.

By adopting these guidelines, clinicians can promote long-term graft survival, reduce cardiovascular complications, and improve patient outcomes in the evolving transplantation landscape in Taiwan.