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Risk of cardiovascular events in kidney transplant recipients undergoing PCI: a systematic review and meta-analysis

Isabella Ellison1, Riley Batchelor2, Geoffrey Hill3

  • 1Medical Doctor, Department of Cardiology and The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia.

The British Journal of Cardiology
|August 8, 2026
PubMed

Insights

Kidney transplant recipients (KTR) undergoing percutaneous coronary intervention (PCI) have lower in-hospital mortality than CKD patients or those on dialysis. However, KTRs show similar mortality to patients without chronic kidney disease (CKD) post-PCI.

Area of Science:

  • Nephrology
  • Cardiology
  • Transplantation Medicine

Background:

  • Cardiovascular disease (CVD) is a major cause of mortality in chronic kidney disease (CKD) and kidney transplant recipients (KTR).
  • The comparative risk of major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI) in KTR versus non-KTR populations remains unclear.
  • Understanding these risks is crucial for optimizing cardiovascular care in KTR.

Purpose of the Study:

  • To systematically evaluate and compare in-hospital mortality and MACE rates following PCI in KTR versus non-KTR cohorts.
  • To assess whether KTR status influences cardiovascular outcomes after PCI compared to patients with CKD or end-stage renal disease on dialysis.
  • To provide evidence-based insights into the cardiovascular risk profile of KTR undergoing PCI.

Main Methods:

  • A systematic literature search was performed across MEDLINE, EMBASE, and CENTRAL up to December 2024.
  • Six studies involving 13,287,090 patients were included in the meta-analysis.
  • A random-effects model was employed to pool data and analyze in-hospital mortality and MACE outcomes.

Main Results:

  • KTR undergoing PCI demonstrated significantly lower in-hospital mortality compared to patients with CKD (OR 0.44, 95% CI 0.35-0.55).
  • No significant difference in in-hospital mortality was observed between KTR and patients without CKD (OR 1.12, 95% CI 0.75-1.68).
  • KTR showed a lower incidence of MACE compared to patients on hemodialysis (OR 0.43, 95% CI 0.20-0.92).

Conclusions:

  • PCI in KTR is associated with reduced in-hospital mortality compared to CKD patients and those on dialysis.
  • KTR undergoing PCI do not experience higher mortality risk compared to individuals without CKD.
  • These findings highlight a potentially protective effect of kidney transplantation on cardiovascular outcomes post-PCI.

Keywords:
cardiovascular eventschronic kidney diseasedialysiskidney transplantpercutaneous coronary intervention (PCI)

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