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Abstract: FR-PO744

Hypercholesterolemia Is Associated with Cardiovascular Morbidity and Mortality Among Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Agur, Timna, Rabin Medical Center, Petah Tikva, Central, Israel
  • Nagel, Noam, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Tel Aviv, Israel
  • Bielopolski, Dana, Rabin Medical Center, Petah Tikva, Central, Israel
  • Steinmetz, Tali, Rabin Medical Center, Petah Tikva, Central, Israel
  • Zingerman, Boris, Rabin Medical Center, Petah Tikva, Central, Israel
  • Rahamimov, Ruth, Rabin Medical Center, Petah Tikva, Central, Israel
  • Rozen-zvi, Benaya, Rabin Medical Center, Petah Tikva, Central, Israel

Hypercholesterolemia is highly prevalent among kidney transplant recipients (KTR). Unlike the general population, the correlation between hypercholesterolemia and cardiovascular disease in KTR has not been well established. Therefore, we investigated the association between abnormal cholesterol profiles and cardiovascular morbidity and mortality in this unique population


We conducted a single-center retrospective cohort study that included all adult KTR who had a functioning graft for at least 12 months after transplantation, between January 2005 and April 2014. The primary outcome was a Major Adverse Cardiovascular Event (MACE) defined as non-fatal myocardial infarction, non-fatal CVA, coronary revascularization, hospitalization for acute coronary syndrome and cardiovascular mortality. The secondary outcome was all-cause mortality. To calculate exposure to abnormal cholesterol levels, we used a time-weighted average (TWA) calculation, for LDL-C and HDL-C. MACE risk was analyzed using a multivariate and univariate time-varying Cox model.


The study included 737 KTR, with a median follow-up of 2920 days. The TWA level of LDL-C decreased from 91.6±22.8 mg/dL during the first year to 89.5±20.7 during the 7th year (p=0.021). The TWA level of HDL-C increased from 49.2±12.7 mg/dl to 50.5±13 (p=0.012).
A total of 126 patients (17.6%) experienced a MACE event. A correlation was found between high LDL-C levels and MACE risk by multivariate analysis (HR 1.008 per mg/dL, 95%CI 1.001 – 1.016), while low HDL-C levels were not significantly associated with MACE (HR 0.992 per mg/dl, 95%CI 0.976 – 1.009). Higher LDL-C/HDL-C ratios were significantly associated with an increased risk of MACE in both univariate and multivariate analyses (HR 1.502, per unit, 95%CI 1.147-1.968), as well as all-cause mortality (HR 1.35 per unit, 95%CI 1.06 – 1.71).


Exposure to high LDL-C /HDL-C ratio among KTR is associated with an increased risk of cardiovascular morbidity and mortality