Cardiovascular Risk in Recipients With Kidney Transplants From Expanded Criteria Donors

被引:15
作者
Blanca, L. [1 ]
Jimenez, T.
Cabello, M.
Sola, E.
Gutierrez, C.
Burgos, D.
Lopez, V.
Hernandez, D.
机构
[1] Hosp Univ Carlos Haya, Dept Nephrol, Malaga 29010, Spain
关键词
LEFT-VENTRICULAR HYPERTROPHY; RENAL-TRANSPLANTATION; SURVIVAL; OUTCOMES; PATIENT; DISEASE;
D O I
10.1016/j.transproceed.2012.09.086
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Introduction. Posttransplant cardiovascular disease (CVD) is the leading cause of death in renal transplant (RT) recipients and is more evident in recipients with transplants from expanded criteria donors (ECD). Objecties. We analyzed the evolution of cardiovascular risk factors and their association with patient mortality. Materials and methods. We undertook a single-center, prospective study of RT patients (n = 360) between 1999 and 2006. These were 180 recipients with transplants from ECD and 180 controls. We analyzed the baseline characteristics and the cardiovascular risk factors: hypertension, diabetes, dyslipidemia, CVD, and anemia. Posttransplant analyses included the evolution of cardiovascular risk factors and causes of death. Results. The mean age of the ECD was 63.5 +/- 5.4 versus 32.0 +/- 13.2 years in the non-ECD (P < .001) and the recipient ages were 58.4 +/- 8.7 versus 40.8 +/- 13.3 years, respectively (P < .001). The median interquartile range [IQR] dialysis time was 25 months (15-39) versus 20 months (12-44; P = .017). The pretransplant body mass index was 26.89 +/- 3.91 versus 25.43 +/- 4.72 kg/m(2) (P = .002); the median (IQR) number of antihypertensive drugs was two (1-2) versus two (1-2.75; P = .015); dyslipidemia was present in 32.5% versus 21.6% (P = .024), diabetes in 10.6% versus 5.6% (P = .087), and CVD in 13.3% versus 7.8% (P = .086). Treatment with erythropoiesis-stimulating agents (ESA) was received by 84.9% versus 83.9% (P = .857). Concerning transplantation, the mean follow-up was 64.3 +/- 33.7 months. Hypertension was present at 3 and 5 years in 85.6% versus 69.5% (P = .001) and 87.9% versus 72.8% (P = .009), respiratory. Treatment with angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers at 3 and 5 years was 79.8% versus 64.5% and 85.6% versus 65%. Dyslipidemia was present at 5 years in 63.1% versus 58.0% (P = .482). De novo diabetes occurred in 16.7% versus 11.1% (P = .128), and CVD in 13.5% versus 4.5% (P = .003). Univariate and multivariate Cox regression proportional hazards models were constructed to analyze the factors associated with patient death. Conclusions. CVD is the most common cause of death in recipients of ECD, RT, 40% in the ECD group versus 28.6% in the control group. Tight control of cardiovascular risk factors and a good pretransplant patient selection contributed to the good results obtained.
引用
收藏
页码:2579 / 2581
页数:3
相关论文
共 15 条
[1]   Associations between pre-kidney-transplant risk factors and post-transplant cardiovascular events and death [J].
Aalten, Jeroen ;
Hoogeveen, Ellen K. ;
Roodnat, Joke I. ;
Weimar, Willem ;
Borm, George F. ;
de Fijter, Johan W. ;
Hoitsma, Andries J. .
TRANSPLANT INTERNATIONAL, 2008, 21 (10) :985-991
[2]  
Agarwal R, 2007, CURR OPIN NEPHROL HY, V16, P409
[3]   Development of diabetes mellitus following kidney transplantation: A Canadian experience [J].
Gourishankar, S ;
Jhangri, GS ;
Tonelli, M ;
Wales, LH ;
Cockfield, SM .
AMERICAN JOURNAL OF TRANSPLANTATION, 2004, 4 (11) :1876-1882
[4]  
GRAY JR, 1992, SEMIN NEPHROL, V12, P343
[5]   Regression of left ventricular hypertrophy by lisinopril after renal transplantation:: Role of ACE gene polymorphism [J].
Hernández, D ;
Lacalzada, J ;
Salido, E ;
Linares, J ;
Barragán, A ;
Lorenzo, V ;
Higueras, L ;
Martín, B ;
Rodríguez, A ;
Laynez, I ;
González-Posada, JM ;
Torres, A .
KIDNEY INTERNATIONAL, 2000, 58 (02) :889-897
[6]   Renin-angiotensin system blockade and kidney transplantation: a longitudinal cohort study [J].
Hernandez, Domingo ;
Muriel, Alfonso ;
Abraira, Ctor ;
Perez, German ;
Porrini, Esteban ;
Marrero, Domingo ;
Zamora, Javier ;
Manuel Gonzalez-Posada, Jose ;
Delgado, Patricia ;
Rufino, Margarita ;
Torres, Armando .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2012, 27 (01) :417-422
[7]   Predicting Coronary Heart Disease after Kidney Transplantation: Patient Outcomes in Renal Transplantation (PORT) Study [J].
Israni, A. K. ;
Snyder, J. J. ;
Skeans, M. A. ;
Peng, Y. ;
Maclean, J. R. ;
Weinhandl, E. D. ;
Kasiske, B. L. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2010, 10 (02) :338-353
[8]   Hypertension after kidney transplantation [J].
Kasiske, BL ;
Anjum, S ;
Shah, R ;
Skogen, J ;
Kandaswamy, C ;
Danielson, B ;
O'Shaughnessy, EA ;
Dahl, DC ;
Silkensen, JR ;
Sahadevan, M ;
Snyder, JJ .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2004, 43 (06) :1071-1081
[9]   KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease - Foreword [J].
Levin, Adeera ;
Rocco, Michael .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2006, 47 (05) :S9-S145
[10]   Treatment With Ezetimibe in Kidney Transplant Recipients With Uncontrolled Dyslipidemia [J].
Lopez, V. ;
Gutierrez, C. ;
Gutierrez, E. ;
Sola, E. ;
Cabello, M. ;
Burgos, D. ;
Gonzalez Molina, M. .
TRANSPLANTATION PROCEEDINGS, 2008, 40 (09) :2925-2926