Medicolegal Reflections about a Case of Cardiac Death after Renal Transplantation

2007 ◽  
Vol 30 (7) ◽  
pp. 649-655
Author(s):  
M. Di Paolo ◽  
B. Guidi
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Renal Transplant ◽  
Cardiac Death ◽  
Graft Loss ◽  
Left Ventricular ◽  
Renal Transplant Recipients ◽  
Post Transplantation ◽  
Coronary Syndrome ◽  
Traditional Risk Factors

Cardiovascular disease is the most common cause of death in patients with renal transplant. Acute coronary syndrome due to coronary artery disease, and left ventricular hypertrophy leading to chronic heart failure account for the majority of sudden arrhythmic deaths after transplantation. Furthermore death with functioning graft represents the main cause of graft loss, particularly after the first post-transplantation year. Although cardiovascular disease leads to morbidity and mortality in renal transplant recipients, its pathogenesis is poorly understood. The high incidence of cardiovascular disease in patients after renal transplant is chiefly due to high occurence and accumulation of traditional risk factors before and after transplantation. Hypertension, post-transplant diabetes mellitus and hyperlipidemia increase the risk for cardiovascular events. Also “non traditional” risk factors are associated with cardiovascular disease. Moreover several immunosuppressive drugs interfere with the cardiovascular system. The authors present a case of cardiac death following renal transplant in a patient with history of cardiovascular disease prior transplantation. Initially treated by hemodialysis, after 3 years he received a cadaveric renal transplant. The post-transplantation period was without surgery complications, immunological or infectious, except for a scarce control of blood pressure. A month after the operation, the patient developed thrombophlebitis, plus extra-peritoneal swelling. After ten days in hospital he suddenly died. The aim of the manuscript is to remark on the legal relevance of patient's consensus to transplant. It is necessary to well inform patients of an operation's risks and complications. Furthermore, the exceeding demand with respect to organ availability raises ethical issues about organ allocation. (Int J Artif Organs 2007; 30: 649–55)

Risk factors for cardiovascular disease in renal transplant recipients: new insights

2000 ◽  
Vol 13 (0) ◽  
pp. S419-S424 ◽  
Author(s):  
R. Marcucci ◽  
M. Zanazzi ◽  
E. Bertoni ◽  
T. Brunelli ◽  
S. Fedi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients

scholarly journals Cardiovascular Biomarkers in Chronic Kidney Disease

2010 ◽  
Vol 29 (4) ◽  
pp. 298-303 ◽  
Author(s):  
Mirjana Đerić ◽  
Velibor Čabarkapa
Keyword(s):  
Oxidative Stress ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Disease ◽  
Left Ventricular ◽  
Calcium Phosphorus ◽  
Traditional Risk Factors ◽  
Cardiovascular Biomarkers

Cardiovascular Biomarkers in Chronic Kidney DiseaseCardiovascular morbidity and mortality are markedly increased in chronic renal failure patients. Although it cannot be regarded as a cardiovascular disease risk equivalent, kidney dysfunction is considered an independent predictor of increased cardiovascular risk that increases with deteriorating kidney function. The association is a very complex one, and the term cardiorenal syndrome is now widely used. Cardiovascular disease in chronic kidney disease patients usually manifests as ischemic heart disease (in the form of angina, acute coronary syndrome or sudden cardiac death), cerebrovascular disease, peripheral vascular disease, and congestive heart failure. Vascular disease includes atherosclerosis and vascular calcifications, and cardiomyopathy comprises left ventricular hypertrophy, cardiac fibrosis and left ventricular systolic and diastolic dysfunction. In addition to the well-established traditional risk factors such as hypertension, hyperlipidemia, insulin resistance and diabetes mellitus, the association is supported by synergistic action of non-traditional risk factors such as excessive calcium-phosphorus load, hyperparathyroidism, anemia, hemodynamic overload, malnutrition, inflammation, hyperhomocysteinemia, altered nitric oxide synthase and increased oxidative stress. This paper summarizes the current understanding of the significance of specific uremic retention solutes, natriuretic peptides, biochemical markers of disorders in calcium-phosphorus homeostasis, systemic inflammation, oxidative stress, and dyslipidemia.

scholarly journals Haptoglobin 2-2 Genotype, Patient, and Graft Survival in Renal Transplant Recipients

2017 ◽  
Vol 27 (4) ◽  
pp. 386-391
Author(s):  
Laust Dupont ◽  
Ivar Anders Eide ◽  
Anders Hartmann ◽  
Jeppe Hagstrup Christensen ◽  
Anders Åsberg ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Graft Survival ◽  
Cardiovascular Mortality ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Genotype 2 ◽  
Haptoglobin Genotype

Background: Cardiovascular disease is the leading cause of death in renal transplant recipients. An association between haptoglobin genotype 2-2 and cardiovascular disease has been found in patients with diabetes mellitus and liver transplant recipients. To date, the role of haptoglobin genotype after renal transplantation has not been studied. Methods: In this single-center retrospective cohort study of 1975 adult Norwegian transplant recipients, who underwent transplantation between 1999 and 2011, we estimated the risk of all-cause and cardiovascular mortality and overall and death-censored graft loss for patients with haptoglobin genotype 2-2 compared to genotype 2-1 or 1-1, after adjustment for confounders and competing risks. Results: We found no associations between haptoglobin genotype 2-2 and cardiovascular mortality (subdistributional hazard ratio 1.08, 95% confidence interval 0.78-1.49; P = .63). We also failed to detect any association between haptoglobin 2-2 genotype and all-cause mortality, overall graft loss, and death-censored graft loss. Similar results were found in the subpopulation of transplant recipients with diabetes. Conclusion: In this large cohort of kidney transplant recipients, we could not demonstrate any association between haptoglobin 2-2 genotype and patient or graft survival after renal transplantation.

scholarly journals A prospective observational study on the traditional and novel risk factors associated with post-transplant diabetes mellitus in renal transplant recipients

Biomedicine ◽  
2021 ◽  
Vol 41 (2) ◽  
pp. 482-488
Author(s):  
Krithika Muralidhara ◽  
Subramanian Kannan ◽  
Ishthiaque Ahamed ◽  
Krishna Kishore ◽  
Llyod Vincent ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Transplant ◽  
Trace Element ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Factors Associated ◽  
Novel Risk Factors ◽  
Traditional Risk Factors

Introduction and Aim: Post Transplant Diabetes Mellitus (PTDM) constitutes a major co-morbidity that has significant impact on the patient and renal allograft outcome. Various traditional risk factors like dialysis vintage, immunosuppressive medication, viral infections have known to be associated with PTDM. Novel risk factors and its causative role in PTDM remains unexplored. The study looked at the incidence of PTDM at 6 months post renal transplantation and correlation of PTDM with known traditional and novel risk factors like pre-transplant C-reactive protein (CRP) level and Trace element deficiency.   Material and Methods: 30 consecutive renal transplant recipients more than 18 years of age were inducted into the study. Demographic data, known pre-transplant and post-transplant risk factors associated with development of PTDM were collected. Pre-transplant CRP and serum Trace element (Aluminum, Copper, Selenium and Zinc) levels were estimated. PTDM was diagnosed by home based glucometer monitoring and confirmed by Oral glucose tolerance test (OGTT).   Results: The incidence of PTDM was 36.6% at six months post renal transplant. Among the pre-transplant risk factors, higher age and positive family history of diabetes mellitus had a strong association with the occurrence of PTDM. Pre-transplant Zinc deficiency emerged as a significant novel risk factor for the development of PTDM.   Conclusion: Apart from known traditional risk factors, novel risk factors are associated with development of PTDM.

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