Background

Globally, among kidney transplant recipients (KTRs), cardiovascular diseases (CVDs) have been the most frequent cause of death with a preserved transplant kidney function, referred to as “death with a functioning graft”.The number of kidney transplant recipients (KTRs) with coexisting diabetes mellitus (DM) and preexisting CVDs, which were identified as the established powerful graded risk factors in terms of post-transplant morbidity and mortality, has increased worldwide. Nevertheless, epidemiologic evidence of CVD in Japanese KTRs is non-existent.

Methods

The objective of this study was to reveal the status of CVD in Japanese KTRs, and to provide and share the clinical features and outcomes with cardiovascular experts who will utilize the findings most effectively in clinical practice. We investigated post-transplant CVDs in 1614 adult KTRs between 1990 and 2014. Coronary heart diseases, heart failure, stroke, arrhythmia, and other related diseases were considered as CVDs. All-cause mortality was also investigated. Final follow-up was performed in March 2016.

Results

During the follow-up period, 309 KTRs experienced CVD and 124 KTRs died. Overall cumulative rates of CVDs were 9.9%, 14.2%, 19.6%, 23.8%, and 26.4% at 3, 6, 9, 12, and 15 years, respectively. All-cause mortality rates in the corresponding period were 2.0%, 3.9%, 6.0%, 9.1%, and 13.1%, respectively, and CVD was the leading cause (35.5%) of overall death. Coexisting DM and preexisting CVD were associated with greatly increased risk of post-transplant CVD (hazard ratio [HR]: 3.44, 95% confidence interval [CI], 2.03–5.82; P < 0.001) and all-cause mortality (HR: 3.32, 95% CI, 1.34–8.22; P = 0.009), despite improvement of return to dialysis-free rate.

Conclusions

The number of KTRs with coexisting DM and preexisting CVD has increased over time. Appropriate cardiovascular screening and development of optimized management strategies for CVDs are required to reduce the incidence of post-transplant CVD in Japanese KTRs.

CITATION INFORMATION: Okumi M, Unagami K, Fujimori D, Hata K, Hirai T, Ishida H, Tanabe K, Japan Academic Consortium of Kidney Transplantation (JACK) Cardiovascular Disease in Japanese Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress