Purpose: To identify factors involved in cardiac events within three months after renal transplantation.

Methods: We conducted a chart review for all renal transplants (RT) performed in 2010 and 2011 in our center. Factors included are type and number of RT, delayed graft function (DGF=need for dialysis after transplantation), previous cardiovascular events, cardiac evaluation on indication according to ESC guidelines, and postoperative decrease in hemoglobin level=[Delta]Hb. A composite end point of any cardiovascular event (ischemia with positive cardiac enzymes, heart failure, and/or coronary intervention) was used.

Results: 354 RT were included, of which 71% living donor RT and 83% first RT. In 58 RT (16%) there was a history of myocardial infarction, revascularization and/or heart failure before RT. All patients underwent cardiac screening of whom 268 ischemia detection. MIBI scan was performed in 130 patients (48 patients with persistent and/or reversible defects); stress ultrasound in 40 patients (1 with ischemia); exercise in 137 patients (6 with ischemia). In 4 patients, the screening led to cardiac revascularization before RT, none of whom had an event. After RT, in 38 transplants a cardiac event occurred: reanimation in 4 RT; acute coronary syndrome in 9 RT (of whom 5 underwent intervention); and heart failure in 16 RT. 4 patients died within three months after transplantation; 3 patients of cardiac cause. In univariate analysis, type of transplant (living or deceased donor), DGF, age, any cardiovascular event before transplantation, myocardial revascularization, myocardial infarct, abnormal MIBI scan result, decreased left ventricular ejection fraction, and [Delta]Hb were all significantly associated with cardiac events within three months after transplantation. In multivariate analysis, type of transplant (RR 2.9, p=0.006), pretransplant myocardial infarction (RR 7.9, p<0.001) and abnormal MIBI scan (RR 2.8, p=0.043) remained associated with cardiovascular events within three months after transplantation.

Conclusion: Despite cardiac evaluation according to ESC guidelines, 11% of renal transplant patients had a cardiac event and 1% cardiac death within 3 months after transplantation. The most vulnerable population for post-transplant cardiac events are recipients known with previous myocardial infarction and abnormal MIBI scan who receive a deceased donor kidney transplantation.

CITATION INFORMATION: Slot M, van de Wetering J, Kho M, Betjes M, Roodnat J. Predictors of Postoperative Cardiovascular Complications Until Three Months After Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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