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Kidney Week

Abstract: PO2509

Recurrent Cardiovascular Events After Kidney Transplant Are Associated with Increased Risk for Graft Failure and Mortality

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Galapia, Leyton, Mayo Clinic, Scottsdale, Arizona, United States
  • Lieske, John C., Mayo Clinic, Rochester, Minnesota, United States
  • Zhang, Nan, Mayo Clinic, Scottsdale, Arizona, United States
  • Butterfield, Richard J., Mayo Clinic, Scottsdale, Arizona, United States
  • Keddis, Mira T., Mayo Clinic, Scottsdale, Arizona, United States
Background

Cardiovascular (CV) disease is prevalent after kidney transplant (KTx). The objective of this study was to describe patients with recurrent CV events in association with allograft function and mortality.

Methods

1148 consecutive adults that received a KTx between 2011-2013 at a single center were evaluated. CV events were defined as: cardiac: myocardial infarction, heart failure, cardiac arrest requiring resuscitation, and vascular, any stroke, or peripheral vascular disease requiring intervention. Recurrent events were defined as more than one event (either cardiac or vascular).

Results

Mean age was 56.0years (SD14.2), 500(44%) were female, 403(35%) had diabetes, 1083(94%) had hypertension, 127(11%) had prior history of CV events, 602(53%) required dialysis, and 867(76%) received living donor KTx. After a median follow-up of 74 months there were 229(20%) deaths and 217(19%) CV events, of which 92(42%) were cardiac, 86(40%) were vascular, 39(18%) had both. 119 patients had an isolated CV event and 98 had recurrent CV events (median 3 (range 2,4)). Multivariate analysis revealed the following independent significant predictors of CV events: older age, prior history of CV event, diabetes, hypoalbuminemia and measured GFR. Compared to recipients with no CV events and those with an isolated event, recipients with recurrent CV events had increased: mortality (15% vs 38% vs 45%,p<0.0001) and graft failure (14% vs 26% vs 40%,p<0.0001). Hazard ratio for mortality associated with isolated CV events was 2.66 (1.90-3.73) compared to a HR 3.06 (2.18-4.29) for recurrent CV events, p<0.0001.[Figure 1]. Predictors of multiple CV events included measured GFR and increased c-reactive protein; on multivariate analysis only measured GFR was predictive.

Conclusion

Prevalence of recurrent CV events after KTx was 8.5%. Patients with recurrent CV events are at increased risk for mortality and graft failure. Decreased graft function was the primary predictor of recurrent CV events.