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Abstract

Objectives: Stroke is a major cause of mortality in the general population but data regarding stroke-related hospitalization or mortality after a kidney transplant is limited. We determined risk for stroke-related episodes after a kidney transplant in a populationbased cohort study of 19 103 kidney allograft recipients in England between 2001 and 2012. Materials and Methods:The incidence of stroke-related events after a kidney transplant with pretransplant history of stroke, the incidence of stroke-related hospitalization or death among all kidney allograft recipients after a kidney transplant, and risk factors for stroke-related mortality after a kidney transplant were examined. Data were obtained from hospital episode statistics (an administrative data warehouse that contains admissions to all National Health Service hospitals in England) and is linked to the Office for National Statistics, which collects information on all registered deaths in England. Results: There were 782 nonfatal stroke-related hospitalizations and 113 stroke-related deaths (5.4% of total deaths) after a kidney transplant (median follow-up 4.4 y after a kidney transplant). Risk for allcause mortality was higher for those recipients with, compared to those without, a history of stroke (21.5% vs 10.8%; P < .001). However, risk for stroke-related mortality after a kidney transplant was no different. Kidney allograft recipients with nonfatal stroke episodes after a transplant were at a higher risk for allcause and stroke-related mortality. In a Cox regression model, pretransplant history of stroke was an independent risk factor for all-cause mortality, but not stroke-related mortality, while posttransplant hospitalization with nonfatal stroke was a risk factor for both. Conclusions: Fatal and nonfatal stroke-related events are common among kidney allograft recipients. Further research is warranted to allow better risk stratification and facilitate clinical trials for risk attenuation of stroke after a kidney transplant. Key words: Cerebrovascular accident, Death, Transplant IntroductionStroke, or cerebrovascular accidents, is one of the leading causes of mortality in the world, estimated to be the second leading cause of global death by the World Health Organization. 1 In 2010, the global absolute numbers of individuals developing their first stroke, surviving stroke, or having a stroke-related death were 16.9 million, 33.0 million, and 5.9 million, with 69% of events occurring in individuals aged greater than 65 years. 2 In addition, stroke-related disability represents a significant health burden, with disability-adjusted life years lost an estimated 102 million globally in 2010. 2 Although age-standardized rates of stroke-related mortality are decreasing worldwide, 2,3 absolute numbers are increasing and they represent a major public health burden.In the context of transplant, the effect of strokerelated morbidity or mortality after a transplant is unclear because of a lack of published data. Oliveras and colleagues observed a 10-...