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Cardiovascular risk in renal transplant recipients.

ABSTRACT: Successful kidney transplantation offers patients with end-stage renal disease the greatest likelihood of survival. However, cardiovascular disease poses a major threat to both graft and patient survival in this cohort. Transplant recipients are unique in their accumulation of a wide range of traditional and non-traditional cardiovascular risk factors. Hypertension, diabetes, dyslipidaemia and obesity are highly prevalent in patients with end-stage renal disease. These risk factors persist following transplantation and are often exacerbated by the drugs used for immunosuppression in organ transplantation. Additional transplant-specific factors such as poor graft function and proteinuria are also associated with increased cardiovascular risk. However, these transplant-related factors remain unaccounted for in current cardiovascular risk prediction models, making it challenging to identify transplant recipients with highest risk. With few interventional trials in this area specific to transplant recipients, strategies to reduce cardiovascular risk are largely extrapolated from other populations. Aggressive management of traditional cardiovascular risk factors remains the cornerstone of prevention, though there is also a potential role for selecting immunosuppression regimens to minimise additional cardiovascular injury.

SUBMITTER: Devine PA

PROVIDER: S-EPMC6482292 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Cardiovascular risk in renal transplant recipients.

Devine Paul A PA Courtney Aisling E AE Maxwell Alexander P AP

Journal of nephrology 20181107 3

Successful kidney transplantation offers patients with end-stage renal disease the greatest likelihood of survival. However, cardiovascular disease poses a major threat to both graft and patient survival in this cohort. Transplant recipients are unique in their accumulation of a wide range of traditional and non-traditional cardiovascular risk factors. Hypertension, diabetes, dyslipidaemia and obesity are highly prevalent in patients with end-stage renal disease. These risk factors persist follo ...[more]

PMID: 30406606

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Project description:ImportanceMelanoma risk factors and incidence in renal transplant recipients can inform decision making for both patients and clinicians.ObjectiveTo determine risk factors and characteristics of renal transplant recipients who develop melanoma.Design, setting, and participantsThis cohort study of a large national data registry used a cohort of renal transplant recipients from the United States Renal Data System (USRDS) database from the years 2004 through 2012. Differences in baseline characteristics between those who did and did not develop melanoma were examined, and a survival analysis was performed. Patients with renal transplants who received a diagnosis of melanoma according to any inpatient or outpatient claim associated with a billing code for melanoma were included. A history of pretransplant melanoma, previous kidney transplantation, or transplantation after 2012 or before 2004 were exclusion criteria. The data analysis was conducted from 2015 to 2016.ExposureReceipt of a renal transplant.Main outcomes and measuresIncidence and risk factors for melanoma.ResultsOf 105?174 patients (64?151 [60.7%] male; mean [SD] age, 49.6 [15.3] years) who received kidney transplants between 2004 and 2012, 488 (0.4%) had a record of melanoma after transplantation. Significant risk factors for developing melanoma vs not developing melanoma included older age among recipients (mean [SD] age, 60.5 [10.2] vs 49.7 [15.3] years; P?<?.001) and donors (42.6 [15.0] vs 39.2 [15.1] years; P?<?.001), male sex (71.5% vs 60.7%; P?<?.001), recipient (96.1% vs 66.5%; P?<?.001) and donor (92.4% vs 82.9%; P?<?.001) white race, less than 4 HLA mismatches (44.9% vs 37.1%; P?=?.001), living donors (44.7% vs 33.7%; P?<?.001), and sirolimus (22.3% vs 13.2%; P?<?.001) and cyclosporine (4.9% vs 3.2%; P?=?.04) therapy. Risk factors significant on survival analysis included older recipient age (hazard ratio [HR] per year, 1.06; 95% CI, 1.05-1.06; P?<?.001), recipient male sex (HR, 1.53; 95% CI, 1.25-1.88; P?<?.001), recipient white race, living donors (HR, 1.35; 95% CI, 1.11-1.64; P?=?.002), and sirolimus (HR, 1.54; 95% CI, 1.22-1.94; P?<?.001) and cyclosporine (HR, 1.93; 95% CI, 1.24-2.99; P = .004) therapy. The age-standardized relative rate of melanoma in USRDS patients compared with Surveillance, Epidemiology, and End Results patients across all years was 4.9. A Kaplan-Meier estimate of the median time to melanoma among those patients who did develop melanoma was 1.45 years (95% CI, 1.31-1.70 years).Conclusions and relevanceRenal transplant recipients had greater risk of developing melanoma than the general population. We believe that the risk factors we identified can guide clinicians in providing adequate care for patients in this vulnerable group.

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Cardiovascular risk in renal transplant recipients.

Publications

Cardiovascular risk in renal transplant recipients.

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