After renal transplantation, patient survival is shorter and cardiac events are more likely to occur.
Pre-existing coronary artery disease (CAD) decreases survival of patients following renal transplantation, study findings suggest.
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Edward Cole, MD, and his colleagues at Toronto General Hospital divided 429 renal transplant recipients into high-risk and low-risk groups based on the presence of one or more of the following: pretransplant angina, MI, and a positive coronary angiogram. The researchers compared the groups for post-transplant cardiac events and patients and graft survival.
Of the 429 patients, 45 (10.5%) had post-transplant cardiac events: 31.3% in the high-risk group compared with 6.5% in the low-risk group, according to findings published in Clinical Transplantation (2007;21:609-614). Five-year patient survival was significantly lower in the high-risk than the low-risk group (82.8% vs. 93.1%), but five-year graft survival did not differ significantly between the groups (74.8% vs. 84.1%, respectively).
In the high-risk group, 41% of patients treated with angioplasty plus stenting by bypass grafting prior to transplantation experienced post-transplant cardiac events compared with 28% of recipients without coronary interventions and 6.5% in the low-risk group. Significant independent predictors of post-transplant cardiac events included age, pre-transplant cardiac disease, arrhythmias, and low-ejection fraction (40% or less).
Although post-transplant survival of patients with known CAD is lower than that of low-risk patients, it remains acceptable, the researchers concluded. Cardiac interventions may decrease the perioperative risk, but do not reduce the probability of post-transplant cardiac events to that of the low-risk patients, they stated.
