Comparative Ability of Different Metabolic Syndrome Definitions To Predict Major Adverse Cardiovascular Events after Kidney Transplantation
Medicine, University of Toronto, Toronto, ON, Canada
Renal Transplant Program, St. Michael's Hospital, Toronto, ON, Canada
Meeting: 2013 American Transplant Congress
Abstract number: 121
Background: Metabolic syndrome (MS) refers to a clustering of factors that increases cardiovascular risk. There are at least 4 definitions of MS: International Diabetes Federation 2006 (IDF), World Health Organization 1999 (WHO), US National Cholesterol Education Program Adult Treatment Panel III 2001 (NCEP), and American Heart Association (AHA)/Updated NCEP 2004. The predictive ability of each definition for major adverse cardiac events (MACE) after kidney transplantation has not been compared.
Methods: After excluding patients with type 1 diabetes (N=30), we performed a 1998-2010 single-centre cohort study of 1182 adult single-organ kidney transplant recipients (KTR) followed to 6/30/2012. Demographics and pertinent cardiovascular risk and transplant-related variables were collected from a computerized database. MACE was defined as a composite of myocardial infarction, coronary revascularization, hospitalization for congestive heart failure, stroke, or cardiac death. Reports of angina were excluded. Measurements pertaining to MS definitions were obtained at 3 months post-transplant with MACE occurring prior to 3 months considered as previous cardiac disease. Pre-existing and new-onset diabetes were combined as a single variable. Events were adjudicated from 3 months post-transplant to 6/30/2012. MACE-free survival between MS and non-MS KTR by each definition was compared by Kaplan-Meier methodology and the log-rank test.
Results: For the entire cohort, age was 49 ± 13 y, 62% were male, 60% Caucasian, 15% smokers, 10% had DGF, 12% acute rejection, 62% were on hemodialysis pre-transplant, 71% on tacrolimus, and 18% had previous cardiac disease. Table 1 shows MACE rates by each MS definition.
| MS Definition | N | Years F/U | MACE | MACE Rate/100 patient years | P-value | |
| IDF | No | 638 | 4166 | 76 | 1.82 | 0.703 |
| Yes | 544 | 3281 | 67 | 2.04 | ||
| WHO | No | 677 | 4642 | 72 | 1.55 | 0.019 |
| Yes | 505 | 2805 | 71 | 2.53 | ||
| NCEP | No | 617 | 4060 | 68 | 1.67 | 0.191 |
| Yes | 565 | 3387 | 75 | 2.21 | ||
| Updated NCEP | No | 581 | 3844 | 63 | 1.64 | 0.150 |
| Yes | 601 | 3603 | 80 | 2.22 |
Conclusion: Among MS definitions, the WHO definition is the best predictor of MACE in KTR and can therefore be used to identify high-risk patients early post-transplant. Transplant programs should consider measuring parameters contained within the WHO definition such as waist and hip circumference and urine albumin excretion.
To cite this abstract in AMA style:
Prasad G, Huang M, Silver S, Allawati A, Rapi L, Nash M, Zaltzman J. Comparative Ability of Different Metabolic Syndrome Definitions To Predict Major Adverse Cardiovascular Events after Kidney Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/comparative-ability-of-different-metabolic-syndrome-definitions-to-predict-major-adverse-cardiovascular-events-after-kidney-transplantation/. Accessed May 14, 2025.« Back to 2013 American Transplant Congress