Renal transplant recipients with coronary artery disease exhibit impairment in fibrinolysis and structural changes in carotid arteries

Cardiovascular disease (CVD) is the main cause of mortality and morbidity among kidney transplant recipients (Tx). Intima-media thickness (IMT) of the common carotid artery is related to CVD. Hemostatic disturbances may contribute to the CVD pathogenesis in Tx. The aim of the study was to evaluate some hemostatic factors in Tx with and without coronary artery disease (CAD) and their correlations with IMT. Patients with CAD were significantly older, with thicker IMT, lower plasmin-antiplasmin complexes (PAP), higher fibrinogen, cholesterol, triglycerides, Thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and activity, prolonged euglobulin clot lysis time when compared to those without CAD. Kidney transplant recipients have higher mean blood pressure, serum lipids, fibrinogen, TAFI antigen, TAFI activity, markers of coagulation and fibrinolysis, thicker IMT and lower PAP relative to healthy volunteers. In univariate analysis, IMT correlated significantly with age, time on dialysis prior to transplantation, PAP, fibrinogen, hematocrit, body mass index (BMI). Multiple regression analysis showed that only age, hematocrit, PAP, and time on dialysis prior to transplantation were positive independent predictors of IMT. Hypofibrinolysis may contribute to the arterial remodeling in Tx. Dialysis therapy before transplantation makes detrimental changes in arterial vasculature.