*Purpose: AKI was found to be associated with increased risk of major cardiovascular events (MACE) in the general population. Patients after kidney transplantation are prone to AKI events and are also at increased risk of cardiovascular disease due to the combination of both traditional and nontraditional risk factors. The association between AKI and MACE in kidney transplant patients has yet to be studied.

*Methods: This retrospective single center cohort study reviewed 416 adult renal allograft recipients transplanted between January 2005 and December 2010. AKI events were recorded starting two weeks after transplantation, or following discharge with a functioning graft. AKI was defined, according to the KDIGO criteria, as an elevation in SCr of 50% or more from baseline. The primary outcome was the composite of MACE starting six months after transplantation and all-cause mortality. For survival analysis we used univariate and multivariate time varying Cox proportional hazard model.

*Results: 124 patients (29.8%) had a least one episode of AKI. During the median follow-up time of 7.2 years (IQR 4.3-9.1) 144 outcome events occurred. By time varying Cox regression analysis AKI was associated with increased rate of CV outcomes or death (Hazard Ratio (HR) 1.96, 95% Confidence Interval (CI) 1.36-2.81, p<0.001), and the association remained significant by multivariate adjusted model (HR 1.76, CI 1.18-2.63, p=0.005). While there was no association between AKI and CVD in women, in men we observed an association with highly increased risk (p=0.011). As for the different components of MACE, all-cause mortality and cardiovascular mortality were the only outcomes that were significantly associated with AKI. No interaction between AKI timing and MACE was found.

*Conclusions: AKI in kidney transplant recipient is associated with MACE. These findings may suggest that we should consider interventions to reduce cardiovascular morbidity in these patients.

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