Major Adverse Cardiovascular Events Following Simultaneous Pancreas and Kidney Transplantation. A Study of the United Kingdom Transplant Registry

P. Yiannoullou,^1,2 A. Summers,^1,2 C. Fullwood,² Z. Moinuddin,^1,2 I. Shapey,^1,2 H. Khambalia,^1,2 T. Augustine,^1,2 M. Rutter,^1,2 D. van Dellen.^1,2

¹Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
²University of Manchester, Manchester, United Kingdom.

Meeting: 2018 American Transplant Congress

Abstract number: 373

Keywords: High-risk, Multivariate analysis, Survival

Session Information

Session Name: Concurrent Session: Pancreas and Islet - 1

Session Type: Concurrent Session

Date: Monday, June 4, 2018

Session Time: 4:30pm-6:00pm

Presentation Time: 4:54pm-5:06pm

Location: Room 4C-3

Background

Patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD) suffer increased cardiovascular morbidity and mortality. Simultaneous pancreas and kidney transplantation (SPKT) improves survival, but cardiovascular complications remain a significant cause of post-transplant death. We assessed the relationship between pre-transplant recipient factors and major adverse cardiovascular events (MACE) following SPKT.

Methods

The United Kingdom Transplant Registry prospectively records data on every SPKT recipient. Records were examined for MACE, defined as cardiovascular mortality, non-fatal myocardial infarction (MI) or non-fatal cerebrovascular accident (CVA). Clinical variables were related using univariable and multivariable-adjusted Cox regression.

Results

Between 2001-2015, 1699 SPKT were performed. 133 patients (7.8%) experienced a MACE, 56% (n=74) of which were fatal. The median time to event was 913 days (interquartile range (IQR): 138-1606). In multivariable analysis, recipient age (Hazard ratio (95% confidence interval): 1.04(1.01-1.06)), baseline history of MI (2.57 (1.32-5.01)), CVA (2.23 (1.10-4.49)) or amputation (2.23 (1.10-4.49)) all predicted post transplant MACE after controlling for year of transplant, CIT and donor history of hypertension. MACE also related to shorter pancreas and renal allograft survival (2214 vs. 3832 days, p<0.001; 2410 vs. 4320 days, p<0.001).

Conclusions

Cardiovascular disease is related to early allograft loss and is a significant cause of recipient morbidity and mortality. MI, CVA or amputation pre-transplant strongly relate to MACE after transplantation. Pre-existing vascular disease should therefore be given greater emphasis during recipient selection for SPKT. Patients with these risk factors should be offered enhanced cardiovascular risk assessment and risk factor optimization. Further research is needed to assess the potential impact of modifiable risk factors and prehabilitation on CVD outcomes in SPKT recipients.

CITATION INFORMATION: Yiannoullou P., Summers A., Fullwood C., Moinuddin Z., Shapey I., Khambalia H., Augustine T., Rutter M., van Dellen D. Major Adverse Cardiovascular Events Following Simultaneous Pancreas and Kidney Transplantation. A Study of the United Kingdom Transplant Registry Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Yiannoullou P, Summers A, Fullwood C, Moinuddin Z, Shapey I, Khambalia H, Augustine T, Rutter M, Dellen Dvan. Major Adverse Cardiovascular Events Following Simultaneous Pancreas and Kidney Transplantation. A Study of the United Kingdom Transplant Registry [abstract]. https://atcmeetingabstracts.com/abstract/major-adverse-cardiovascular-events-following-simultaneous-pancreas-and-kidney-transplantation-a-study-of-the-united-kingdom-transplant-registry/. Accessed November 21, 2024.

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