Pre-transplant predictors of cerebrovascular events after kidney transplantation

被引:34
作者
Aull-Watschinger, Susanne [1 ]
Konstantin, Hermina [2 ]
Demetriou, Demetrakis [2 ]
Schillinger, Martin [3 ]
Habicht, Antje [2 ]
Hoerl, Walter H. [2 ]
Watschinger, Bruno [2 ]
机构
[1] Med Univ Vienna, Dept Neurol, Vienna, Austria
[2] Med Univ Vienna, Dept Internal Med 3, Vienna, Austria
[3] Med Univ Vienna, Dept Internal Med 2, Vienna, Austria
关键词
atrial fibrillation; left ventricular function; outcome; renal transplantation; stroke;
D O I
10.1093/ndt/gfm766
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. We evaluated cerebrovascular events (CVE) after kidney transplantation (KTx) and sought to identify pre-transplant predictors of transient ischaemic attacks (TIA) and strokes post-transplantation. Methods. A total of 1617 consecutive kidney and 16 kidneypancreas recipients transplanted between 1995 and 2005 were analysed in this retrospective single-centre study. Risk factors for CVE, e.g. recipient and donor age and gender, diagnosis of chronic kidney disease, end-stage renal disease (ESRD) duration, histories of hypertension, hyperlipidaemia, smoking, atrial fibrillation (AF), diabetes mellitus (DM), ischaemic heart, peripheral- and cerebro-vascular disease, as well as pre-transplant myocardial infarction or CVE (i.e. TIAstrokes) were analysed. Furthermore, the predictive value of pre-transplant screening tests, i.e. echocardiography (n = 1184) and carotid ultrasound (n = 922), was investigated. Results. During a median follow-up of 4 years, 64 CVE (54 strokes and 10 TIA) were observed. Nineteen (5.1) of 373 deceased patients died from fatal stroke. Recipient age, history of AF and hyperlipidaemia (P = 0.00, respectively), reduced left ventricular function (LVF) (P = 0.01) and the degree of stenosis by carotid ultrasound (P = 0.002), duration of ESRD (P = 0.03) and interstitial nephritis as renal disease cause (P = 0.04) evolved as predictors of TIAstroke post-transplant in univariate analysis. In multivariable analysis, AF (P = 0.001) and DM (P = 0.037) were significant predictors for post-transplant CVE. Conclusions. AF and DM are independent predictors of CVE after KTx. Beyond their general ability to detect sev- erely comorbid patients, pre-transplant screening tests (e.g. carotid ultrasound or echocardiography) were not able to identify renal transplant candidates at risk for CVE after transplantation.
引用
收藏
页码:1429 / 1435
页数:7
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