Cardiac Events After Kidney Transplantation According to Pretransplantation Coronary Artery Disease and Coronary Revascularization Status

• Published in: Transplantation proceedings 2016, Vol.48 (1), p.65-73
• Main Authors: Felix, R, Saparia, T, Hirose, R, Almers, L, Chau, Q, Jonelis, T, Zheng, S, Zaroff, J
• Format: Article
• Language: English
• Subjects: Aged; California; Coronary Angiography - statistics & numerical data; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Disease Progression; Endovascular Procedures - statistics & numerical data; Female; Follow-Up Studies; Humans; Kidney Transplantation - adverse effects; Male; Middle Aged; Postoperative Complications - etiology; Preoperative Period; Proportional Hazards Models; Retrospective Studies; Severity of Illness Index; Surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2015.12.028

Abstract Objectives The aims of this study were to compare the rates of cardiovascular events among renal transplant recipients according to pre-transplantation coronary artery disease (CAD) and revascularization status and to describe the coronary angiographic findings in patients with post-transplantation events. Methods This was a retrospective cohort study of patients who had coronary angiography within 2 years before kidney transplantation. The predictor variables were pre-transplantation CAD and coronary revascularization. The primary outcome was a composite of cardiovascular mortality, acute coronary syndrome, and post-transplantation revascularization. Results The study included 403 patients. Pre-transplantation CAD was present in 73%, and 22% were revascularized. During a follow-up period of 5.6 years, the primary outcome occurred in 5% of the subjects without CAD, in 23% of those with CAD and no revascularization, and in 26% of those with CAD and revascularization (CAD hazard ratio [HR], 4.39 [ P  = .002]; revascularization HR, 1.27 [ P  = .36]). Thirty-five patients had a primary outcome and repeated coronary angiography, which demonstrated progression of previously nonsevere disease in the majority of cases. Conclusions Adverse cardiovascular outcomes are common after renal transplantation and are associated with pre-transplantation CAD of any severity. Secondary prevention of CAD events should be a high priority in the management of this high-risk population.