Cardiovascular events following renal transplantation: Role of traditional and transplant-specific risk factors

Cardiovascular mortality is increased in transplant recipients. However, studies including non-fatal events are critical to assess the burden of disease and to identify novel risk factors. We described the incidence of fatal and non-fatal events, and explored associations and interactions among traditional and transplant- specific risk factors and cardiovascular events (CVE) in a cohort of 922 patients transplanted between 1993 and 1998. One hundred and seventy-six patients experienced 201 CVE ( 111 cardiac, 48 cerebrovascular, 42 peripheral-vascular). Most CVE were non-fatal. Factors associated with cardiac events were ( adjusted hazard ratios) tobacco (3.53; P < 0.001), obesity (2.92; P < 0.001), diabetes (2.63; P < 0.001), multiple rejections (2.19; P = 0.008), prior CVE (2.0; P = 0.004), dialysis 41 year (1.91; P = 0.007), and overweight status (1.68; P = 0.04); with cerebrovascular events: diabetes and peritoneal dialysis (11.95; P < 0.001), age 445 (6.77; P < 0.001), diabetes (4.87; P < 0.001), prior CVE (3.73; P < 0.001), creatinine 4141 mu mol/l (3.16; P = 0.001), peritoneal dialysis (3.06; P = 0.027), and obesity (0.32; P = 0.046); with peripheral-vascular events: diabetes (8.48; P < 0.001), tobacco and cytomegalovirus (3.88; P < 0.001), age 445 (2.31; P = 0.019), and prior CVE (2.25; P = 0.016); with mortality: tobacco and deceased-donor (3.52; P < 0.001), age 445 (1.81; P = 0.002), diabetes (1.76; P 0.002), pulse pressure (1.64; P = 0.029), prior CVE (1.52; P 0.04), and dialysis 41 year (1.47; P 0.04). The majority of CVE post-transplant were non-fatal. Previous CVE was strongly associated with CVE post-transplant. Interactions among transplant- specific and traditional risks impacted significantly the incidence of CVE. Modifiable factors such as duration of dialysis, deceased-donor transplantation, and acute rejection should be viewed as cardiovascular risks.