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.
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.