Graft Loss and Acute Coronary Syndromes after Renal Transplantation in the United States

Abbott, Kevin C.; Bucci, Jay R.; Cruess, David F.; Taylor, Allen J.; Agodoa, Lawrence Y.

doi:10.1097/01.asn.0000028800.84746.cb

Cited by 51 publications

(39 citation statements)

References 26 publications

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“…Results were similar in sensitivity analyses that incorporated censoring at waiting list removal for indications other than transplantation. These findings resonate with recent evidence of reduced risk for cardiac morbidity and mortality after transplantation but increased risk after graft loss (2)(3)(4)(5)(6)25,26). This study is limited by its retrospective design and our inability to confirm objectively clinically coded diagnoses.…”

Section: Discussionsupporting

confidence: 75%

Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

Lentine

Rey

Kolli

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: This study examined the risks, predictors, and mortality implications of cerebrovascular disease events after kidney transplantation in a national cohort.Design, setting, participants, & measurements: This analysis used United States Renal Data System registry data to study retrospectively Medicare-insured kidney transplant candidates (n ‫؍‬ 51,504), recipients (n ‫؍‬ 29,614), and recipients with allograft failure (n ‫؍‬ 2954) in 1995 through 2002. New-onset cerebrovascular disease events including ischemic stroke, hemorrhagic stroke, and transient ischemic attacks were ascertained from billing records, and participants were followed until Medicare-end or December 31, 2002. Multivariable survival analysis was used to compare cerebrovascular disease event incidence and risk profiles among the study samples.Results: The cumulative, 3-yr incidence of de novo cerebrovascular disease events after transplantation was 6.8% and was lower than adjusted 3-yr estimates of 11.8% on the waiting list and 11.2% after graft loss. In time-dependent regression, transplantation predicted a 34% reduction in subsequent, overall cerebrovascular disease events risk compared with remaining on the waiting list, whereas risk for cerebrovascular disease events increased >150% after graft failure. Similar relationships with transplantation and graft loss were observed for each type of cerebrovascular disease event. Smoking was a potentially preventable correlate of posttransplantation cerebrovascular disease events. Women were not protected. All forms of cerebrovascular disease event diagnoses after transplantation predicted increased mortality.Conclusions: Along with known benefits for cardiac complications, transplantation with sustained graft function seems to reduce risk for vascular disease events involving the cerebral circulation.

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Section: Discussionsupporting

confidence: 75%

Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

Lentine

Rey

Kolli

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…In the event of graft failure, ACS incidence was around double that of RTRs who had a functioning graft (12.1 vs 6.5 per 1000 patientyears). As a time dependent variable, graft loss had a HR of 2.54 [84] . Well established CV risk factors such as hypertension, dyslipidaemia and hyperglycaemia can all be worsened by graft dysfunction.…”

Section: Renal Impairmentmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

116

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

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“…Although we have demonstrated an independent association of BPH and AUR, UTI, and allograft loss, we cannot comment on the specific mechanism of graft loss. Limitations specific to the methods of USRDS database research have been described previously (25).…”

Section: Limitationsmentioning

confidence: 99%

Incidence, Predictors, and Associated Outcomes of Prostatism after Kidney Transplantation

Hurst¹,

Neff²,

Falta³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Results: The 3-yr incidence of BPH post-transplant was 9.7%. The incidences of AUR, UTI, and TURP after BPH diagnosis (up to 3 yr posttransplant) were 10.3%, 6.5%, and 7.3% respectively, and each was significantly associated with BPH. Cox regression analysis showed that recipient age per year, later year of transplant, and dialysis vintage were associated with incident BPH. Using Cox nonproportional hazards regression, BPH was significantly associated with renal allograft loss (including death).Conclusions: BPH is common in males after renal transplant and is independently associated with AUR, UTI, and graft loss. It is unknown whether treatment of BPH, either medical or surgical, attenuates these risks.

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Graft Loss and Acute Coronary Syndromes after Renal Transplantation in the United States

Cited by 51 publications

References 26 publications

Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

Cardiovascular risk factors following renal transplant

Incidence, Predictors, and Associated Outcomes of Prostatism after Kidney Transplantation

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