Impact of kidney transplantation on the progression of cardiovascular disease

Satyan, Sangeetha; Rocher, Leslie L.

doi:10.1053/j.arrt.2004.04.010

Cited by 8 publications

(5 citation statements)

References 221 publications

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“…This study extends previous work by considering the differential impact of transplantation on other factors that commonly complicate renal transplantation (12,13). It was gratifying to see no difference in hypertension, hypercholesterolemia or hypertriglyceridemia between the two ethnic groups and not surprising to see a major difference in the incidence of post-transplant diabetes mellitus.…”

Section: Discussionsupporting

confidence: 79%

Renal Transplantation in Indo-Asian Patients in the UK

Dooldeniya

Dupont

et al. 2006

American Journal of Transplantation

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Membership of some ethnic groups has an effect on renal transplant outcome but little is known about the impact of Indo-Asian ethnicity, despite this group's high incidence of renal disease. We compared outcomes in Indo-Asians and Caucasians at the Hammersmith Hospital (Indo-Asians, N = 46; Caucasians, N = 90), in the Long-Term Efficacy and Safety Surveillance (LOTESS) database of cyclosporin-treated renal transplant recipients (Indo-Asians, N = 254; Caucasians, N = 4262) and the National Transplant Database held by UK Transplant (Indo-Asians, N = 459; Caucasians, N = 4831). The baseline demographic and co-morbid characteristics of the two ethnic groups were comparable, save for more diabetes in the Indo-Asian community. Following transplantation, the incidence of delayed graft function and steroid-resistant acute rejection were also comparable, as were graft and patient survival (out to 5 years) and graft function. In addition, post-transplant blood pressure, levels of cholesterol and triglycerides and exposure to corticosteroids and cyclosporin were comparable. However, when patients who were not diabetic before transplantation were studied separately, there was an increased incidence of diabetes in the Indo-Asian community (Hammersmith data: Indo-Asians 10.9% vs. Caucasians 3.3%, p = 0.02; LOTESS data Indo-Asians 5.5% vs. Caucasians 1.6%, p < 0.0001). Subsequent management of this group should pursue immunosuppressive regimens less likely to impair post-transplant glucose tolerance.

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Section: Discussionsupporting

confidence: 79%

Renal Transplantation in Indo-Asian Patients in the UK

Dooldeniya

Dupont

et al. 2006

American Journal of Transplantation

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“…In patients with CAD, the concentration of EPCs strongly correlates with the number and severity of cardiovascular risk factors (13). Patients with chronic kidney disease and RT have an increased risk of developing cardiovascular disease that is the most frequent cause of death in these patients (1)(2)(3)(4)(5). Our findings of reduced EPCs in RT patients suggest that their deficiency may play a role in endothelial dysfunction and increased cardiovascular risk in kidney transplant recipients.…”

Section: Discussionmentioning

confidence: 66%

“…The risk of cardiovascular disease in renal transplant patients (RT) is higher than in the general population. This increased risk has been ascribed to accelerated atherosclerosis and impaired angiogenesis (1). Currently, coronary artery disease (CAD) is one of the most important causes of morbidity and mortality in patients with renal disease (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Circulating Endothelial Progenitor Cells After Kidney Transplantation

Soler

Martínez-Estrada

Puig-Marí

et al. 2005

American Journal of Transplantation

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Circulating endothelial progenitor cells (EPCs) promote vascular repair and maintain integrity of the endothelial monolayer. Reduced EPCs number has been associated with endothelial dysfunction in various cardiovascular diseases. Cardiovascular disease risk is higher in renal transplant patients (RT) than the general population. We studied EPCs number and proliferation in RT, and examined the association with other cardiovascular risk factors such as reduced glomerular filtration rate (GFR) and LDL cholesterol. EPCs concentration was determined in 94 RT and 39 control subjects (C) by flow cytometry. EPCs proliferation was also studied after 7 days in culture. EPCs concentration was significantly reduced in RT versus C (median 33.5 [5-177] vs. 53 [9-257] EPCs/10 5 PMN cells, p = 0.006). EPCs proliferation was also reduced in RT versus C (mean ± SD; 372.7 ± 229.3 vs. 539.8 ± 291.3 EPCs × field, p = 0.003). In multiple regression analysis, GFR, HDL, LDL and body weight were independent predictors of EPCs concentration in RT (r 2 = 0.25, p < 0.001). EPCs number is reduced in RT, particularly in patients with reduced GFR. Moreover, EPCs from RT studied in vitro, showed reduced proliferation, which is a sign of functional impairment. These alterations may be involved in increased cardiovascular risk of RT.

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“…Approximately 80% of patients with heart failure and systolic–diastolic dysfunction die within 3 years ( 51 ). Despite the clearly positive effect of a functional transplanted kidney on cardiac function, patients with a history of heart failure have a more than two times higher risk of heart failure or death, even 5 years after transplantation ( 52 , 53 ). This risk increases as the ejection fraction decreases ( 54 ).…”

Section: Discussionmentioning

confidence: 99%

Standardized risk-stratified cardiac assessment and early posttransplant cardiovascular complications in kidney transplant recipients

Rajnochova Bloudickova,

Janek,

Machackova

et al. 2024

Front. Cardiovasc. Med.

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IntroductionCardiovascular disease (CVD) is the leading cause of morbidity and mortality in kidney transplant recipient (KTR). There is a dearth of standardized guidelines on optimal cardiovascular evaluation of transplant candidates.MethodsThis single-center cohort study aims to determine the effectiveness of our standardized risk-stratified pretransplant cardiovascular screening protocol, which includes coronary angiography (CAG), in identifying advanced CVD, the proper pretransplant management of which could lead to a reduction in the incidence of major cardiac events (MACE) in the early posttransplant period.ResultsOut of the total 776 KTR transplanted between 2017 and 2019, CAG was performed on 541 patients (69.7%), of whom 22.4% were found to have obstructive coronary artery disease (CAD). Asymptomatic obstructive CAD was observed in 70.2% of cases. In 73.6% of cases, CAG findings resulted in myocardial revascularization. MACE occurred in 5.6% (N = 44) of the 23 KTR with pretransplant CVD and 21 without pretransplant CVD. KTR with posttransplant MACE occurrence had significantly worse kidney graft function at the first year posttransplant (p = 0.00048) and worse patient survival rates (p = 0.0063) during the 3-year follow-up period compared with KTR without MACE. After adjustment, the independent significant factors for MACE were arrhythmia (HR 2.511, p = 0.02, 95% CI 1.158–5.444), pretransplant history of acute myocardial infarction (HR 0.201, p = 0.046, 95% CI 0.042–0.970), and pretransplant myocardial revascularization (HR 0.225, p = 0.045, 95% CI 0.052–0.939).ConclusionAsymptomatic CVD is largely prevalent in KTR. Posttransplant MACE has a negative effect on grafts and patient outcomes. Further research is needed to assess the benefits of pretransplant myocardial revascularization in asymptomatic kidney transplant candidates.

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Impact of kidney transplantation on the progression of cardiovascular disease

Cited by 8 publications

References 221 publications

Renal Transplantation in Indo-Asian Patients in the UK

Renal Transplantation in Indo-Asian Patients in the UK

Circulating Endothelial Progenitor Cells After Kidney Transplantation

Standardized risk-stratified cardiac assessment and early posttransplant cardiovascular complications in kidney transplant recipients

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