Monday July 02, 2018 from 09:45 to 11:15
Cardiovascular Disease after Kidney Transplant from Uncontrolled Donation after Circulatory Death (uDCD).
Maria Molina1, Jimena Cabrera2, Esther Gonzalez1, Natalia Polanco1, Ana Hernandez1, Eduardo Gutierrez1, Amado Andres1.
1Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain; 2Department of Nephrology, Hospital Evangelico, Montevideo, Uruguay
Introduction: Cardiovascular diseases (CVD) are the most frequent cause of mortality in kidney transplant (KT) recipients, and 50% of these deaths are due to ischemic heart disease (IHD). The recipients of KT from uDCD received more frequently induction therapy with lymphocytes depleting antibodies and higher dose of inhibitor of calcineurin. The incidence of CVD after this kind of KT is unknown.
Aim: To analyse the prevalence and the incidence of CVD events in our program of KT from uDCD after 100 months of follow up and to determinate the risk factors that are involved in the development of this complication.
Material and Methods: We included 237 RT from uDCD between 2005 and 2013. We reviewed donors, recipients, procurement and evolution characteristics. We reported CVD eventes: IHD, cerebrovascular accidents and peripheral vascular disease (PVD) or death attributable to CVD.
Results: Recipient's age was 48±11 y and 141 (59.5%) were male. Pretransplantation cardiovascular risk factors were: 77.2% (183) hypertension, 22.8% (54) diabetes mellitus and 39.2% (93) dyslipidemia. CVD pretransplantation were: 5.5% (13) IHD, 4.6% (11) stroke and 3.8% (9) PVD. Mean follow up was 44±27 (25-63) months. The prevalence of CVD was 8.8% and the incidence was 27 cases/1000 patient-years. Of the 21 CVD events in 20 patients, 55% (11) were IHD, 35% (7) stroke and 10% (3) PVD. Multivariable analysis shown the following risk factors to develop for any CVD event: pretransplantation IHD (HR: 9.2 (3.2-26.8) p<0.001), pretransplantation PVD (HR: 4.2 (1.1-15.4) 0=0.02), previous cerebrovascular accidents (HR: 4.2 (1.4-12) p=0.008), recipient’s age at transplantation (HR: 1.05 (1.006-1.1) p=0.04), body mass index of recipient at transplantation (HR: 1.12 (1.004-1.2) p=0.04), diabetes mellitus (HR: 2.8 (1.03-7.9) p=0.04), dyslipidaemia (HR: 2.5 (1-6.1) p=0.05) and serum creatinine at 6 month (HR: 2 (1.1-3.5) p=0.02). Hepatitis C, donor gender or proteinuria didn’t increase CDV risk.
Conclusions: The incidence of CVC events following renal transplantation of uDCD donors is low and is related to the previous history of CVC events, the age of the recipient, the recipient body mass index, presence of diabetes, dyslipedaemia and renal function at 6 months. Neither the type of immunosuppression or the development of acute rejection were risk factors for the development of CVC events. Then, renal transplant recipients with pre-KT CVC events require a wide pre-transplant vascular study and a close post KT follow-up.