Associations between pre-kidney-transplant risk factors and post-transplant cardiovascular events and death

The prevalence of cardiovascular risk factors in renal transplant candidates is high. A better understanding of the relation between these risk factors and cardiovascular morbidity and mortality is mandatory to improve transplantation outcome. In this retrospective cohort study 2187 adult patients who received a first kidney transplant between 1984 and 1997 were included. We analyzed the incidence of post-transplant cardiovascular events and tried to identify independent pretransplant risk factors for post-transplant cardiovascular events and all-cause mortality. The cumulative incidence of post-transplant cardiovascular events was 40%. The incidence was highest in the first 3 months after transplantation. Independent pretransplant risk factors for a post-transplant cardiovascular event were diabetic nephropathy Hazard ratio (HR) 3.02; 95% CI 2.85-3.98, claudication HR 2.17 (1.42-3.31), cardiac event HR 1.76 (1.32-2.33), cerebrovascular accident HR 1.53 (1.03-2.28), time-on-dialysis HR 1.06 (1.02-1.11), recipient age HR 1.04 (1.04-1.05), and body mass index HR 1.03 (1.00-1.05). Diabetic nephropathy and cardiovascular disease were also important predictors for all-cause mortality. Diabetic nephropathy and cardiovascular disease were the most important predictors for cardiovascular events and all-cause mortality after renal transplantation. Early treatment of cardiovascular risk factors and pretransplant cardiovascular evaluation might improve transplantation outcome.