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Charlotte Andersson, MD



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Charlotte Andersson, MD, PhD; Martina McGrath, MD; Finnian Mc Causland, MBBCh, MMSc; Morten Schou, MD, PhD; Lars Køber, MD, DSc; Marc A Pfeffer, MD, PhD

Principal Investigator

Marc A Pfeffer, MD, PhD

Research Category: Cardiovascular, Diabetes, and Metabolic Disorders


Long-term cardiovascular events, graft failure, and mortality in kidney transplant recipients

Scientific Abstract

Background and aims: Kidney transplant recipients (KTRs) are at higher risk of cardiovascular events and kidney failure than the general population, but contemporary risk estimates are sparse. Using the Danish administrative databases, we quantified 5-year risks among first-time KTRs and 10 age- and sex-matched controls.

Methods and results: Cumulative 5-year incidence of cardiovascular events (myocardial infarction, stroke, or heart failure), graft failure (re-transplantation or need for dialysis >30 days post-transplant), and mortality following transplantation were calculated for 2,598 KTRs (median age 50 [25-75th percentile 40-61] years, 36% females) and 25,980 controls. 5-year cumulative incidence of myocardial infarction, stroke, or heart failure was 8.3% (7.1%-9.5%) for KTRs and 2.4% (2.2%-2.6%) for controls. For the kidney transplant cohort, cumulative 5-year mortality was 10.3% (9.0%-11.6%), while the cumulative incidence of dialysis and re-transplantation was 16.4% (14.8%-18.0%), compared with 2.9% (2.7%-3.2%) and 0.4% (0.3%-0.5%) for the controls. Risks were similar for those who received kidneys from living and deceased donors and did not change over calendar time.

Conclusions: KTRs have markedly higher long-term cardiovascular disease, graft failure, and mortality risks, compared with age- and sex-match individuals from the general population. Better preventive strategies are warranted to improve prognosis in this high-risk group of patients.

Lay Abstract

Kidney transplant recipients are at higher risk of developing cardiovascular disease than the general population, but data from a modern era are sparse and would be important to further guide preventive strategies to improve long-term cardiovascular outcomes in this patient group. Using the Danish nationwide administrative databases, we quantified the 5-year risks among all first-time kidney transplant recipients (2005-2018) and 10 age- and sex-matched controls from the background population. We included a total of 2,598 kidney transplant recipients (average age 50 years, 36% females) and 25,980 controls. After 5 years, myocardial infarction, stroke, or heart failure had occurred in 8.3% of the transplant recipients versus 2.4% of the background population. These data underscore the need for better preventive strategies to mitigate the higher cardiovascular risks of kidney transplant recipients.

Clinical Implications

These data highlight the need for interventional studies testing preventive strategies for cardiovascular disease and graft failure among kidney transplant recipients.