Cardiovacular diseases are the first cause of mortality after renal transplantation. The purpose of this study was to analyze early cardiovascular events occurrence after kidney transplantation and to evaluate our screening strategy.

Material and methods: 283 renal transplant recipients (RTR) who were above 50 years old when listed were included. Results of pre-transplant cardiac work-up were analysed: clinical evaluation, electrocardiogram, echocardiography, Thallium stress test (n=197) and coronarography (n=81). Occurrence of cardiovascular events was collected during the first year post transplantation.

Results: 62% of patients had more than 4 cardiovascular risk factors pre-transplant: high blood pressure (95%), dyslipidaemia (81%), smoking (45%), diabetes mellitus (37%) and a past cardiovascular clinical history (21%). Electrocardiogram showed 18.5% of abnormalities (Left Ventricular Hypertrophy (LVH), rhythm or repolarization alterations). Echocardiography showed: LVH in 50% of cases, dyskinesia in 10%, Ejection Fraction < 55% in 9%. Thallium scintigraphy was abnormal in 13 % of patients and coronarography disclose 10% of artery disease. Pre-transplant screening revealed undiagnosed coronary disease in 6% of cases. Following transplantation, 15% (38/244) of patients experienced a cardiovascular event in a mean delay of 2± 2 days: acute coronary syndrome (n=7/38), isolated troponin increase (n=14/38) or atrial fibrillation (n=7/38). No patient died.

Pre-transplant parameters associated with a cardiovascular event (multivariate analysis) were: a past medical history of cardiovascular disease (OR= 2,06; p=0,03), echocardiographic LVH (OR=2,04; p=0,037) and an abnormal thallium scintigraphy (OR=2,25 [1,09;5,96]; p=0,03). Other traditional cardiovascular risk factors as BMI, dyslipidemia or diabetes were not significant.

Conclusion: Pre-transplantation screening diagnosed coronary disease in 6% of patients. An early cardiovascular event after transplantation was observed in 15% of RTR including 3% of acute coronary syndrome. Past medical history of cardiovascular disease, pre-transplant LVH and abnormal thallium scintigraphy significantly predicted the occurrence of a cardiovascular event after transplantation.

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