Background: Metabolic syndrome (MS) refers to a clustering of factors that increases cardiovascular risk. The WHO 1999 definition of MS includes the presence of any one of diabetes (DM), impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or insulin resistance, plus at least two among BP ≥ 140/90 mmHg ; TG ≥ 1.695 mmol/L and HDL-C ≤ 0.9 mmol/L (M), ≤ 1.0 mmol/L (F); waist-hip ratio >0.90 (M), >0.85 (F), or BMI>30 kg/m²; and urinary albumin ≥ 20 ¯o;g/min or albumin:creatinine ratio ≥ 30 mg/g. The predictive ability of each for major adverse cardiovascular events (MACE) after kidney transplantation has not been compared.

Methods: After excluding patients with type 1 diabetes (N=30), we performed a 1998-2010 cohort study of 1182 adult single-organ kidney recipients (KTR) followed to 6/30/2012. Demographics and pertinent cardiovascular variables were collected from a computerized database. MACE was defined as a composite of MI, coronary revascularization, hospitalization for CHF, stroke, or cardiac death. Measurements pertaining to MS definitions were obtained at 3 mo post-transplant with MACE occurring prior to 3 mo considered as previous cardiac disease. Pre-existing and new-onset DM were combined as a single variable. Events were adjudicated from 3 months post-transplant to 6/30/2012. MACE-free survival was compared by Kaplan-Meier methodology and log-rank test.

Results: For the entire cohort, age was 49 ± 13 y, 62% were male, 60% Caucasian, 15% smokers, 10% had DGF, 12% AR, 62% were on hemodialysis pre-transplant, 71% on tacrolimus, and 18% had previous cardiac disease. There were 143 MACE. Table 1 shows MACE rates by MS component.

Adding various MS components to DM/IGT/IFG provided a maximum HR of 1.946 (1.37-2.75) for 1 added component, 3.284 (1.72-6.26) for 2, 4.127 (2.16-7.86) for 3, and 4.282 (2.09-8.76) for all 4 added components.

Conclusion: MS is a risk factor for MACE after kidney transplantation. Most of this is conferred by abnormal glucose metabolism, but adding other components to this increases the risk further.

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