PURPOSE: Kidney transplant (KTx) recipients have increased risk of cardiovascular disease (CVD), related to time on dialysis and post-KTx immunosuppression. To date, the incidence of post-KTx cardiovascular events (CVE) among pediatric KTx recipients (PKTx) has not been well-characterized.

METHODOLOGY: Between 1963 and 2015, 881 pediatric (age: 0-17 years old) recipients received 1055 KTx at our institution. The incidence and type of CVE was assessed. Patient outcomes were compared and the relative risk of developing CVE after PKTx was determined.

RESULTS: After a median follow-up of 16 years, 340 CVE occurred in 164 (18.6%) patients at a median age of 18 y.o. Thrombotic/embolic events and arrhythmias accounted for 20.0% and 14.7% of CVE, respectively. On univariate and multivariate analysis, pre-KTx CVD, cyclosporine A/prednisone maintenance, and graft failure were found to be independent risk factors for CVE (Table 1). Overall, patient survival was excellent in patients who developed CVE (Fig. 1; p<0.001); however, patients needed to survive long enough to develop disease. Graft survival was similar among patients (p=0.26; Fig. 1). The median time to developing a CVE after PKTx was 10 years (Fig. 1). Of patients who developed CVE and died, 53/81 (65.4%) died of CVE causes. Time-dependent analysis of CVE patients demonstrated a significant risk of death (aHR, 2.5 [95% CI 1.6-4.0]).

CONCLUSION: Pre-KTx CVD, maintenance immunosuppression with cyclosporine A/prednisone, and a failed graft are independent risk factors for post-KTx CVE in PKTx recipients. Post-transplant CVD increases the risk of death after PKTx.

CITATION INFORMATION: Serrano O, Bangdiwala A, Vock D, Payne W, Dunn T, Chinnakotla S, Finger E, Kandaswamy R, Pruett T, Matas A, Chavers B. Incidence of Post-Transplant Cardiovascular Disease After Pediatric Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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