Association Between Renal Transplantation and Cardiovascular Risk in Patients Who Have Undergone Contemporary Percutaneous Coronary Intervention

Objective: Renal transplantation improves the survival and quality of life of patients with end-stage renal disease (ESRD).However, the prognostic impact of percutaneous coronary intervention (PCI) in transplant recipients compared to that in patients receiving maintenance hemodialysis (HD) remains unclear.This study evaluated the coronary disease outcomes after PCI with contemporary drug-eluting stents (DESs) in these two populations. Materials and methods:We retrospectively analyzed 110 consecutive patients with ESRD who underwent PCI with second-or third-generation DESs between January 2010 and December 2018.Patients were classified into the transplant group (n = 16, 30 lesions) or the dialysis group (n = 94, 165 lesions).The primary endpoint was the incidence of major adverse cardiac events (MACE), defined as a composite of target vessel revascularization, non-fatal myocardial infarction, or all-cause mortality.Results: At a median follow-up of 2.3 (interquartile range, 1.2-3.7)years, MACE occurred less frequently in the transplant group than in the dialysis group (25.0% vs. 51.1%,log-rank P = 0.004).Multivariable Cox regression adjusted for age, diabetes, smoking, and brain natriuretic peptide confirmed renal transplantation as an independent predictor of reduced MACE risk (hazard ratio 0.2, 95% confidence interval 0.1-0.7;P = 0.009).Although some outcomes did not reach statistical significance, consistent trends were observed in transplant recipients. Conclusion:In the era of second-and third-generation DESs, renal transplant recipients demonstrated more favorable cardiovascular outcomes after PCI than patients on maintenance HD.These findings suggest that renal transplantation may confer cardiovascular benefits beyond renal replacement, although validation in larger multicenter studies is warranted.