Hyperhomocysteinaemia: a significant risk factor for cardiovascular disease in renal transplant recipients

Abstract. Renal transplant recipients have disproportionately high rates of arteriosclerotic outcomes, and recent studies provided controlled evidence that clinically stable renal transplant recipients have an excess prevalence of hyperhomocysteinemia. Few studies suggest that hyperhomocysteinemia may be a cardiovascular risk factor in renal transplant recipients. In the study presented here, the association between atherosclerotic events and homocysteine concentrations was examined in 207 stable renal transplant recipients. The role of hyperhomocysteinemia was analyzed with respect to other known cardio-vascular risk factors. The mean follow-up was 21.2 ± 1.9 mo (range, 14 to 26). Mean total homocysteine (tHcy) was 21.1 ± 9.5 μmol/L and median concentration was 19 μmol/L. Seventy percent of patients (n = 153) were hyperhomocysteinemic (values >15 μmol/L). tHcy correlated negatively with folate concentration (r = -0.3; P <0.01). tHcy was closely related to creatinine concentration (r = 0.54; P < 0.001). Cardiovascular disease events (CVE) including death were observed in 30 patients (14.5%; 7.34 events per 1000 person-months of follow-up). Fasting tHcy values were higher in patients who experienced CVE (31.5 ± 10.3 versus 17.8 ± 7.5; P < 0.001). Cox regression analysis showed that tHcy was a risk factor for cardiovascular complications (relative risk [RR] 1.06; 95% confidence interval (95% CI), 1.04 to 1.09; P < 0.0001). This corresponds to an increase in RR for CVE of 6% per μmol/L increase in tHcy concentration. Age (RR 1.55; 95% CI, 1.09 to 2.19; P < 0.01) and creatinine concentration (RR 1.34; 95% CI, 1.08 to 1.66; P < 0.01) were also independent predictor for CVE. This study demonstrates that elevated fasting tHcy is an independent risk factor for the development of CVE in chronic stable renal transplant recipients. Randomized, place-bo-controlled homocysteine studies of the effect of tHcy lowering on CVE rates are urgently required in this patient population.

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Hyperhomocyst(e)inemia as an independent risk factor for cardiovascular disease in renal transplant recipients.

Transplantation Journal ◽

10.1097/00007890-199805131-00287 ◽

1998 ◽

Vol 65 (Supplement) ◽

pp. 151

Author(s):

Didier DUCLOUX ◽

Christophe RUEDIN ◽

Roger GIBEY ◽

Jean-Michel REBIBOU ◽

Catherine BRESSON-VAUTRIN ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Renal Transplant ◽

Independent Risk Factor ◽

Renal Transplant Recipients ◽

Transplant Recipients

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Cigarette Smoking in Renal Transplant Recipients

Journal of the American Society of Nephrology ◽

10.1681/asn.v114753 ◽

2000 ◽

Vol 11 (4) ◽

pp. 753-759 ◽

Cited By ~ 3

Author(s):

BERTRAM L. KASISKE ◽

DAGMAR KLINGER

Keyword(s):

Cardiovascular Disease ◽

Relative Risk ◽

Renal Transplant ◽

General Population ◽

Cigarette Smoking ◽

Graft Failure ◽

Renal Transplant Recipients ◽

Adjusted Relative Risk ◽

Transplant Recipients ◽

Quit Smoking

Abstract. Cigarette smoking increases the risk for cancer and cardiovascular disease in the general population, but the effects of smoking in renal transplant recipients are unknown. The effects of smoking were investigated among patients transplanted at Hennepin County Medical Center between 1963 and 1997. Information on smoking was available in 1334 patients. The 24.7% prevalence of smoking at the time of transplantation was similar to that in the general population. After adjusting for multiple predictors of graft failure, smoking more than 25 pack-years at transplantation (compared to smoking less than 25 pack-years or never having smoked) was associated with a 30% higher risk of graft failure (relative risk 1.30; 95% confidence interval [CI], 1.04 to 1.63;P= 0.021). Having quit smoking more than 5 yr before transplantation reduced the relative risk of graft failure by 34% (relative risk 0.66; 95% CI, 0.52 to 0.85;P< 0.001). The increase in graft failure was due to an increase in deaths (adjusted relative risk 1.42; 95% CI, 1.08 to 1.87;P= 0.012). The relative risk for major cardiovascular disease events with smoking 11 to 25 pack-years at transplant was 1.56 (95% CI, 1.06 to 2.31;P= 0.024), whereas that of smoking more than 25 pack-years was 2.14 (95% CI, 1.49 to 3.08;P< 0.001). The relative risk of invasive malignancies was 1.91 (95% CI, 1.05 to 3.48;P= 0.032). Smoking had no discernible effect on the rate of return to dialysis or on serum creatinine during the first year after transplantation. Thus, cigarette smoking is associated with an increased risk of death after renal transplantation. The effects of smoking appear to dissipate 5 yr after quitting. These results indirectly suggest that greater efforts to encourage patients to quit smoking before transplantation may decrease morbidity and mortality.

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Donor-recipient age difference?an independent risk factor in cyclosporin-treated renal transplant recipients

Transplant International ◽

10.1007/bf00336403 ◽

1991 ◽

Vol 4 (2) ◽

pp. 88-91 ◽

Cited By ~ 3

Author(s):

Peter Donnelly ◽

Peter Veitch ◽

Peter Bell ◽

Robin Henderson ◽

Paul Oman ◽

...

Keyword(s):

Risk Factor ◽

Renal Transplant ◽

Independent Risk Factor ◽

Age Difference ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Recipient Age

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P1708EFFECT OF PREGNANCY ON KIDNEY TRANSPLANT RECIPIENTS: A PROPENSITY SCORE-MATCHED STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1708 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Toyofumi Abe ◽

Taniguchi Ayumu ◽

Kawamura Masataka ◽

Kato Taigo ◽

Tomoko Namba-Hamano ◽

...

Keyword(s):

Multivariate Analysis ◽

Risk Factor ◽

Kidney Transplant ◽

Graft Survival ◽

Significant Risk ◽

Significant Risk Factor ◽

P Value ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Pregnancy And Delivery

Abstract Background and Aims This study aimed to evaluate whether the experience of pregnancy and delivery would be associated with poor maternal outcome among kidney transplant recipients. Method A total of 401 female transplant recipients from the Osaka University Transplantation Group Database were included in this study. 73 women who underwent renal transplantation between 1970 and 2017 and became pregnant and delivered at Osaka University Kidney Transplant Group Hospitals. Multivariable logistic regression analysis was used to assess the impact of pregnancy and delivery on renal transplant recipient outcome after one-to-one propensity score (PS) matching for 12 variables including serum creatinine at one year post-transplant between the parous group and the nulliparous group. The outcomes were kidney graft survival and patient survival. Results In all patients before PS matching, 75 (18.7%) of the 401 patients died and 137 (34.2%) of the 401 patients lost their kidney grafts during the follow-up period. In the multivariate analysis, pregnancy and delivery was not a significant risk factor for death (adjusted HR 0.662 [95%CI, 0.265-1.656], p-value 0.378) and for death-censored graft survival (adjusted HR 1.224 [95%CI, 0.683-2.196], p-value 0.497). In the PS matched population, 14 (17.5%) of the 80 patients died and 31 (38.8%) of the 80 patients lost their grafts. In the multivariate analysis, pregnancy and delivery was not a significant risk factor for death (adjusted HR 0.611 [95%CI, 0.180-2.072], p-value 0.430) and for death-censored graft survival (adjusted HR 1.308 [95%CI, 0.501-3.416], p-value 0.584). Conclusion Pregnancy and delivery after kidney transplantation was not associated with poor kidney transplant outcome in recipients with adequate and stable graft function.

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Acute kidney injury in renal transplant recipients undergoing cardiac surgery

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa063 ◽

2020 ◽

Vol 36 (1) ◽

pp. 185-196

Author(s):

Gregory L Hundemer ◽

Anand Srivastava ◽

Kirolos A Jacob ◽

Neeraja Krishnasamudram ◽

Salman Ahmed ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Risk Factor ◽

Renal Transplant ◽

Kidney Disease ◽

Kidney Injury ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Trough Levels

Abstract Background Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. Methods We conducted a retrospective cohort study of RTRs (n = 83) and non-RTRs (n = 83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. Results RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36–5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DD-RTRs versus LD-RTRs; P = 0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P = 0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P = 0.004). Conclusions RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.

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