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| Year : 2010 | Volume
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| Issue : 3 | Page : 438-442 |
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| Impact of cardiovascular risk factors on the outcome of renal transplantation |
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Mehrdad Moghimi1, Kianoosh Falaknazi2, Nazila Bagheri2
1 Department of Surgery, Taleghani Medical Center, Shahid Beheshti Medical University, Tehran, Iran
2 Department of Nephrology, Taleghani Medical Center, Shahid Beheshti Medical University, Tehran, Iran
Click here for correspondence address and email
| Date of Web Publication | 26-Apr-2010 |
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 Abstract | | |
Cardiovascular diseases are common in renal transplant recipients and renal insufficiency has been shown to be a risk factor for cardiovascular disease. Some studies have reported that cardiovascular risk factors may contribute to the outcome of renal transplantation. This study was performed to determine the impact of cardiovascular risk factors on the outcome of renal transplantation in Iranian subjects. This is a retrospective, observational study including patients of 2085 years of age who had undergone renal transplantation. Parameters documented and analyzed included demographics, cardiovascular risk factors, past medical history, date of last transplantation, the outcome of transplant, last measured serum creatinine, cause of graft failure, rejection, and death. A total of 192 patients were analyzed including 152 in the case group (with identifiable cardiovascular risk factors) and 40 controls (transplant recipients without identifiable risk factors). The mean serum creatinine in the case and control groups were 1.33 ± 0.13 and 1.29 ± 0.36 mg/dL respectively (P= 0.493). Response to transplantation was categorized based on a report from the World Health Organization. Complete response to grafting occurred in the control group more than the case group (P= 0.009), while frequency of partial response to grafting was higher in the case group (0.008). A history of chronic obstructive pulmonary diseases (COPD) could significantly predict the outcome of grafting (P= 0.008) as could the occurrence of renal failure (P= 0.022). Results were consistently reproduced using multivariate cumulative log it model. Our study indicates that the measured cardiovascular risk factors do not significantly influence the outcome of renal transplantation.
How to cite this article:
Moghimi M, Falaknazi K, Bagheri N. Impact of cardiovascular risk factors on the outcome of renal transplantation. Saudi J Kidney Dis Transpl 2010;21:438-42 |
How to cite this URL:
Moghimi M, Falaknazi K, Bagheri N. Impact of cardiovascular risk factors on the outcome of renal transplantation. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2022 Aug 10];21:438-42. Available from: https://www.sjkdt.org/text.asp?2010/21/3/438/62717 |
| Introduction | |  |
Cardiovascular diseases are more common in renal transplant recipients and are the leading cause of death in them. [1],[2] Renal insufficiency has been shown to be a risk factor for cardiovascular disease. [1] Conversely, some studies have reported that cardiovascular risk factors may influence the outcome of grafting. [3]
Previous studies have shown that cigarette smoking, hypertension, hyperlipidemia and diabetes mellitus are the major independent cardiovascular risk factors. [4] Obesity and family history of coronary heart disease are also among the other cardiovascular risk factors, according to the American Heart Association. [4] Apart from these, age and gender are associated with cardiovascular conditions, although they are not modifiable. [5] European best practice guidelines for renal transplantation suggest that such cardiovascular risk factors as smoking, diabetes mellitus, obesity, hyperlipidemia and hypertension should be controlled in patients who have undergone renal transplantation. [6],[7],[8],[9],[10]
With the increased use and availability of renal transplantation in Iran, it is mandatory to evaluate the risk factors of graft failure or death in this setting. This study is aimed to appraise the role of cardiovascular risk factors on the outcome of renal transplantation in Iranian subjects.
| Methods | | |
A retrospective, observational study was conducted based on the medical records of patients monitored on an outpatient basis and under standard clinical practice conditions. The study population consisted of subjects who were admitted for renal transplantation to the Taleghani Hospital of Shahid Beheshti University of Medical Sciences, Iran, from 1994 to 2007.
We designed a data sheet and recorded the following variables for each patient: age, sex, last measured serum creatinine level, cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, family history and obesity), history of myocardial infarction, heart failure, arrhythmia, chronic pulmonary disease, cerebrovascular accident, peripheral vascular disease, renal failure, previous renal transplantation and the outcome of transplant (categorized as complete response, partial response or no response). Also, we recorded the date of renal transplantation as well as the date of graft rejection, graft failure and/ or death, when applicable. For patients who experienced graft failure, we also recorded the cause of failure such as: failure because of rejection, calcineurin toxicity, other drug toxicities, urinary tract obstruction, infection and vascular disease. In addition, in patients who were dead by the time of filing the sheet, the cause of death was classified as follows: death because of cardiovascular disease, cerebrovascular accidents (CVA), pulmonary embolism, sudden death at home, infections, graft failure, cancer, liver disease or road traffic accident.
The control group was randomly selected from patients who had undergone renal transplantation but had no identifiable risk factors for coronary artery disease. Control subjects were matched with the case group for age and gender.
| Results | | |
A total of 192 patients were included in this study (152 cases and 40 controls). [Table 1] presents the baseline characteristics of the two groups. In the case group, 42 patients had hypertension (27.6%), 22 had hyperlipidemia (14.5%) and 40 had diabetes mellitus (26.3%). Obesity was observed in 64 cases (42.1%), 86 patients had a family history of cardiovascular disease (56.6%) and 54 smoked cigarettes regularly (35.5%). [Table 2] presents the frequency of previous medical conditions in the case group.
The last measured mean serum creatinine value was 1.33 mg/dL (SD= 0.13) in the case group and 1.29 mg/dL (SD= 0.36) in the control group (P= 0.493). Graft failure was observed in 78 patients (51.3%) from the case group and 24 (60.0%) from the control group. Thirty cases (19.7%) and five controls (12.5%) had died by the time of data extraction. [Table 3] and [Table 4] summarize the causes of graft failure and death in the two groups, respectively.
According to the definition of the World Health Organization (WHO) about the criteria of response rate to renal transplantation, the outcome of transplantation is categorized to three levels: complete response, partial response and no response. [13] Complete response was seen in 60 patients (39.5%) from the case group and 25 (62.5%) from the control group (P= 0.009). Partial response was seen in 83 (54.6%) from the case group and 11 (27.5%) from the control group (P= 0.008). Nine patients from the case group and four from the control group did not respond to the grafting (P= 0.080). The mean period after transplantation when allograft rejection occurred was 5.28 years (SD= 1.21) in the case group and 5.87 years (SD= 2.49) in the control group (P= 0.153); graft falure was noted after a mean period, following transplantation, of 3.92 years (SD= 1.79) in the case group and 4.12 years (SD= 1.25) in the control group (P= 0.417). The mean survival of patients (from transplantation date) was 5.98 years (SD= 2.34) in the case group and 6.61 years (SD= 2.15) in the control group (P= 0.110).
We used a univariate general linear model to evaluate the extent to which each of the risk factors can predict the outcome of transplantation. A history of chronic obstructive pulmonary disease (COPD) could significantly predict the outcome of transplantation (P= 0.008) as could the occurrence of renal failure (P= 0.022). The association between the last creatinine value and the outcome of transplantation was marginally insignificant (P= 0.083); we could not find any significant relationship between the other risk factors (age, sex, hypertension, hyperlipidemia, diabetes, cigarette smoking, family history of coronary artery disease, obesity, history of myocardial infarction, heart failure and peripheral vascular disease) and the response to transplantation (all P values were greater than 0.05). Also, history of previous transplantation was not a predictor of the response to current transplantation (P= 0.718).
A multivariate cumulative logic model showed that occurrence of renal failure could predict the outcome of transplantation with an OR of 12.325 in favor of poor response to grafting (P= 0.005), and history of COPD could predict the outcome with an OR of 2.332 (P= 0.042) in the same direction.
| Discussion | | |
A comprehensive review of the results of this study yields the following conclusions: although renal transplantation augments the occurrence of cardiovascular conditions, [12],[13] most of the cardiovascular risk factors are apparently not related to the outcome of the transplantation. Nevertheless, their incidence was different in patients receiving renal transplants, compared to the general population. [13] A previous study based on the data of the last few decades of the 20 th century showed that chronic rejection and infections are responsible for 23% and 16% of graft losses respectively. [14] In our study, these figures were similar for graft rejection, but slightly higher for infections.
We noticed no difference in the outcome of transplantation between the two genders. Previous studies have shown that the cardiovascular complications as well as graft survival occur at a similar rate after renal transplantation in the two genders suggesting that female gender advantage regarding Coronary Heart Diseases (CHD) is not restored following transplantation. [15],[16]
In our study, obesity was not associated with the outcome of grafting. There are reports which claim obesity can cause higher rates of graft failure, [17] but the impact of obesity on kidney transplant outcome continues to be controversial. [18] Renal function was reported to be lower in obese patients, but it was not consistent in all reports. [17] Also, patients from both groups gained weight after transplantation, which may be due to the use of corticosteroids. This phenomenon usually occurs similarly in obese and non-obese patients. [17]
One of the limitations of our study was its retrospective design. However, there are only few cohort studies assessing the role of cardiovascular risk factors in patients receiving renal transplants, [13] and the consistency of our results with the other reports indicates that the retrospective design probably has not resulted in biased measurements.
| References | | |
| 1. | Marcen R. Cardiovascular risk factors in renal transplantation-current controversies. Nephrol Dial Transplant 2006;21(Suppl 3):iii3-8.  |
| 2. | Rigatto C, Parfrey P, Foley R, Negrijn C, Tribula C, Jeffery J. Congestive heart failure in renal transplant recipients: risk factors, outcomes, and relationship with ischemic heart disease. J Am Soc Nephrol 2002;13(4):1084-90. |
| 3. | First MR, Neylan JF, Rocher LL, Tejani A. Hypertension after renal transplantation. J Am Soc Nephrol 1994;4(8 Suppl):S30-6. |
| 4. | Grundy SM, Pasternak R, Greenland P, Smith S Jr, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation 1999;100(13):1481-92. |
| 5. | Black HR. Cardiovascular risk factors. Yale University School of Medicine Heart Book. William Morrow & Co, 92 A.D.: 32-36. |
| 6. | European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.5.3. Cardiovascular risks. Hyperlipidaemia. Nephrol Dial Transplant 2002;17(Suppl 4):26-8. |
| 7. | European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.5.4. Cardiovascular risks. Post-transplant dibetes mellitus. Nephrol Dial Transplant 2002;17 (Suppl 4):28. |
| 8. | European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.5.7. Cardiovascular risks. Obesity and weight gain. Nephrol Dial Transplant 2002;17(Suppl 4):29-30. |
| 9. | European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.5.6. Cardiovascular risks. Smoking. Nephrol Dial Transplant 2002;17(Suppl 4):29. |
| 10. | European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.5.2. Cardiovascular risks. Arterial hypertension. Nephrol Dial Transplant 2002;17(Suppl 4):25-6. |
| 11. | Arican A, Karakayali H, Bilgin N, Haberal M. Results of treatment in renal transplant patients with Kaposi sarcoma: One-center experience. Transplant Proc 2000;32(3):626-8. |
| 12. | Marcen R. Cardiovascular risk factors in renal transplantation-current controversies. Nephrol Dial Transplant 2006;21(Suppl 3):iii3-8. |
| 13. | Rigatto C, Parfrey P, Foley R, Negrijn C, Tribula C, Jeffery J. Congestive heart failure in renal transplant recipients: risk factors, outcomes, and relationship with ischemic heart disease. J Am Soc Nephrol 2002;13(4):1084-90. |
| 14. | Schweitzer EJ, Matas AJ, Gillingham KJ, et al. Causes of renal allograft loss. Progress in the 1980s, challenges for the 1990s. Ann Surg 1991;214(6):679-88. |
| 15. | Oien CM, Reisaeter AV, Os I, Jardine A, Fellstrom B, Holdaas H. Gender-associated risk factors for cardiac end points and total mortality after renal transplantation: Post hoc analysis of the ALERT study. Clin Transplant 2006;20(3):374-82. |
| 16. | Moosa MR. Impact of age, gender and race on patient and graft survival following renal transplantation-developing country experience. S Afr Med J 2003;93(9):689-95. |
| 17. | Pischon T, Sharma AM. Obesity as a risk factor in renal transplant patients. Nephrol Dial Transplant 2001;16(1):14-17. |
| 18. | Kent PS. Issues of obesity in kidney transplantation. J Ren Nutr 2007;17(2):107-13. |
Correspondence Address:
Mehrdad Moghimi
Taleghani Medical Center, Shahid Beheshti Medical University, Tehran
Iran
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 20427865 
[Table 1], [Table 2], [Table 3], [Table 4] |
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| Grosso, G. and Corona, D. and Mistretta, A. and Zerbo, D. and Sinagra, N. and Giaquinta, A. and Tallarita, T. and Ekser, B. and Leonardi, A. and Gula, R. and Veroux, P. and Veroux, M. | | Transplantation Proceedings. 2012; 44(7): 1859-1863 | | [Pubmed] | |
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