Pre-transplant predictors of cerebrovascular events after kidney transplantation

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2008-04, Vol.23 (4), p.1429-1435
• Main Authors: Aull-Watschinger, Susanne, Konstantin, Hermina, Demetriou, Demetrakis, Schillinger, Martin, Habicht, Antje, Hörl, Walter H., Watschinger, Bruno
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Austria - epidemiology; Biological and medical sciences; Echocardiography; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Humans; Incidence; Intensive care medicine; Kidney Failure, Chronic - surgery; Kidney Transplantation - adverse effects; left ventricular function; Male; Medical sciences; Middle Aged; outcome; Postoperative Complications; Prognosis; Proportional Hazards Models; renal transplantation; Retrospective Studies; Risk Factors; stroke; Stroke - diagnosis; Stroke - epidemiology; Stroke - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate - trends
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfm766

Background. We evaluated cerebrovascular events (CVE) after kidney transplantation (KTx) and sought to identify pre-transplant predictors of transient ischaemic attacks (TIA) and strokes post-transplantation. Methods. A total of 1617 consecutive kidney and 16 kidney–pancreas recipients transplanted between 1995 and 2005 were analysed in this retrospective single-centre study. Risk factors for CVE, e.g. recipient and donor age and gender, diagnosis of chronic kidney disease, end-stage renal disease (ESRD) duration, histories of hypertension, hyperlipidaemia, smoking, atrial fibrillation (AF), diabetes mellitus (DM), ischaemic heart, peripheral- and cerebro-vascular disease, as well as pre-transplant myocardial infarction or CVE (i.e. TIA/strokes) were analysed. Furthermore, the predictive value of pre-transplant screening tests, i.e. echocardiography (n = 1184) and carotid ultrasound (n = 922), was investigated. Results. During a median follow-up of 4 years, 64 CVE (54 strokes and 10 TIA) were observed. Nineteen (5.1%) of 373 deceased patients died from fatal stroke. Recipient age, history of AF and hyperlipidaemia (P = 0.00, respectively), reduced left ventricular function (LVF) (P = 0.01) and the degree of stenosis by carotid ultrasound (P = 0.002), duration of ESRD (P = 0.03) and interstitial nephritis as renal disease cause (P = 0.04) evolved as predictors of TIA/stroke post-transplant in univariate analysis. In multivariable analysis, AF (P = 0.001) and DM (P = 0.037) were significant predictors for post-transplant CVE. Conclusions. AF and DM are independent predictors of CVE after KTx. Beyond their general ability to detect sev- erely comorbid patients, pre-transplant screening tests (e.g. carotid ultrasound or echocardiography) were not able to identify renal transplant candidates at risk for CVE after transplantation.