Abstract: TH-PO0916
Cardiovascular Risk in Kidney Transplant Recipients After Exposure to Immunosuppression for Treatment of Glomerulonephritis
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Vardhan, Yashvi Dinesh, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Wyatt, Nicole Elizabeth, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Derebail, Vimal K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Massicotte-Azarniouch, David, University of Ottawa, Ottawa, Ontario, Canada
Background
Cardiovascular (CV) disease remains the leading cause of morbidity and mortality among kidney transplant recipients. Kidney transplant patients with ESKD from glomerulonephritis (GN) may receive significant pre-transplant immunosuppression (PTI). While immunosuppression is crucial therapy, it may contribute to increased CV risk. The influence of prior immunosuppression on post-transplant CV outcomes remains unexplored.
Methods
This retrospective study included adult and pediatric kidney transplant recipients at our institution between January 2005 and March 2020. We included patients with GN as cause of ESKD who received PTI, while the control group included GN patients without PTI and those transplanted for hypertension, polycystic kidney disease, congenital abnormalities of the kidneys and urinary tract, or Alport's syndrome. Patients with diabetes as a cause of ESKD were excluded. The study outcome was major adverse cardiovascular events (MACE) post-transplant, including non-fatal myocardial infarction (MI), non-fatal cerebrovascular accident (CVA), unstable angina (UA), hospitalization for heart failure and cardiovascular death.
Results
We identified 763 kidney transplant recipients: 184 had GN with PTI, 147 had GN without PTI, and 432 non-GN patients. Rates of MI, CVA, HF, UA, and mortality were compared among groups (Table). Overall, MACE events were higher in both GN with PTI and GN without PTI groups when compared to the non-GN group. GN with PTI had elevated risk of MACE when compared to the overall control group (21.7% vs 12.6%).
Conclusion
Kidney transplant recipients with ESKD due to GN experienced higher rates of MACE and overall mortality compared to non-GN patients. These findings suggest that while higher cumulative immunosuppression burden due to PTI may not be associated with MACE, underlying native disease may have an impact that continues after transplantation. While these are preliminary results with a small population, this study provides a foundation for better understanding how PTI and GNs can independently impact CV risk in kidney transplant recipients.
Summary of Major Adverse Cardiovascular Events Post-Transplant
| Native Disease (n) | MI (n,%) | CVA (n,%) | HF (n,%) | UA (n,%) | CV death (n,%) | Total MACE (n,%) | Mortality (n,%) | |
| GN with PTI (184) | 11 (5.98) | 3 (1.63) | 13 (7.07) | 6 (3.26) | 7 (3.80) | 40 (21.74) | 35 (19.02) | |
| Control | GN without PTI (147) | 12 (8.16) | 9 (6.12) | 15 (10.20) | 9 (6.12) | 3 (2.04) | 48 (26.09) | 28 (19.05) |
| Other (432) | 6 (1.39) | 5 (1.16) | 9 (2.08) | 1 (0.23) | 4 (0.93) | 25 (5.79) | 51 (11.81) | |