Decreasing cardiovascular events after kidney transplantation: a Finnish analysis covering 1990-2019

Cardiovascular prognosis has improved in the general population during the past decades, but it is unclear if this trend explains the better cardiovascular outcomes in kidney transplant recipients.

We obtained data of all first kidney transplant recipients (n = 4942) in Finland 1990-2019 from the Finnish Transplantation Registry and the Finnish Care Register for Health Care. We analyzed post-transplant non-fatal cardiovascular events [acute myocardial infarction (AMI) or stroke] and compared the risk in patients transplanted in 1990-99, 2000-09, and 2010-19. We also compared the incidences of cardiovascular events in kidney transplant patients with the general population of Finland using age and sex-adjusted standardized incidence ratios.

There were 811 non-fatal cardiovascular events during the follow-up time (median 7.4 years, interquartile range 3.5-13.4), with 137 events within the first post-transplant year. Long-term cardiovascular-event risk was significantly higher in adjusted analyses in patients transplanted in 1990-99 than in 2000-09 (HR 0.75, 95% CI 0.63-0.89) or 2010-19 (HR 0.78 95% CI 0.63-0.97). The standardized incidence ratio compared with the general population declined from 4.61 to 1.65 for AMI and from 3.62 to 1.13 for stroke between 1990-94 and 2015-20.

The adjusted risk of post-transplant cardiovascular events has decreased after the 1990s. The incidence of cardiovascular events, especially AMI, has declined more in kidney transplant patients than in the general population. Therefore, better cardiovascular outcomes of kidney transplant patients are not only explained by the improved prognosis of the general population.