Predictors of cardiovascular events and associated mortality within two years of kidney transplantation

Background Cardiovascular disease is the most common cause of death after renal transplantation. Furthermore, acute coronary syndrome (ACS) attributable to coronary artery disease (CAD) accounts for the majority of deaths due to cardiovascular disease posttransplant. While renal transplantation is the treatment of choice for end-stage renal disease, understanding the causes of graft and patient loss is exceedingly important to improve outcomes. Methods This observational case-controlled study included 780 patients who underwent a kidney transplant between 1989 and 2001 who experienced early ACS (within 2 years). Patients were compared with controls matched for gender, year of transplant, and age. The primary outcome was the occurrence of an ACS event within 2 years after renal transplantation. Results Cardiovascular disease was the most common cause of death, with all 13 cardiovascular deaths due to CAD. An additional 15 episodes of nonfatal ACS episodes occurred. Thirty-seven percent of early ACS occurred perioperatively, the majority in the first 3 posttransplant months. On multivariate analysis, diabetes (OR [odds ratio] 5.56; P = .0007), smoking (OR 3.56; P = .034), and prior transplant (OR 2.81; P = .047) were associated with early ACS. Conclusions Diabetes, smoking, and prior transplant were significantly associated with early ACS. The majority of events occurred perioperatively or within 3 months of transplant, highlighting the importance of improved screening and perioperative management.