Major Cardiovascular Complications of Index Kidney Transplantation Hospitalizations: A National Inpatient Sample Analysis

Background. Understanding perioperative risks and long-term benefits of kidney transplantation is essential for patient counseling and optimization of posttransplant outcomes. Currently, there is a lack of generalizable data on cardiovascular complications of kidney transplantation. Methods. We performed a retrospective, cross-sectional analysis of adult kidney transplantation hospitalizations in the National Inpatient Sample from 2016 to 2022. Cardiac events were defined as cardiac arrest, cardiogenic shock, acute myocardial infarction, ventricular tachycardia, or a related cardiac intervention (cardiopulmonary resuscitation, extracorporeal membrane oxygenation, percutaneous coronary intervention, left or right heart catheterization, intra-aortic balloon pump). Outcomes included cardiac event incidence, mortality, length of stay (LOS), and cost. Results. Among 139 720 kidney transplantation hospitalizations, cardiac events occurred in 3165 (2.3%). Patients with cardiac events were older (59.2 versus 52.3 y; P < 0.001) and had higher comorbidity burden (Charlson Comorbidity Index 4.4 versus 3.2; P < 0.001). In-hospital mortality among those with cardiac events was 9.2%, compared with 0.4% among those without. Mean LOS (13.4 versus 5.7 d) and hospitalization cost ($108 876 versus $66 985) were increased in those with a cardiac event ( P < 0.001 for both). Cardiac intervention was recorded in 0.8% of transplant recipients and was associated with a 16.6% mortality rate. Risk factors for cardiac events included older age, male sex, coronary artery disease, congestive heart failure, atrial fibrillation, cerebrovascular disease, diabetes, and Charlson Comorbidity Index > 4 (odds ratio, 4.95; 95% confidence interval, 4.21-5.82; P < 0.001). Conclusions. Cardiac events complicate approximately 2% of index kidney transplantation hospitalizations and are associated with markedly increased mortality, LOS, and cost.