NDT Advance Access originally published online on November 28, 2007
Nephrology Dialysis Transplantation 2008 23(4):1429-1435; doi:10.1093/ndt/gfm766
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Pre-transplant predictors of cerebrovascular events after kidney transplantation
1 Department of Neurology, Medical University of Vienna, Austria 2 Department of Internal Medicine III, Medical University of Vienna, Austria 3 Department of Internal Medicine II, Medical University of Vienna, Austria
Bruno Watschinger, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090 Wien, Austria. Tel: +43-1-40-400-2195; Fax: +43-1-40-400-2194; E-mail: bruno.watschinger{at}meduniwien.ac.at
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Abstract |
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Background. We evaluated cerebrovascular events (CVE) after kidney transplantation (KTx) and sought to identify pre-transplant predictors of transient ischaemic attacks (TIA) and strokes post-transplantation.
Methods. A total of 1617 consecutive kidney and 16 kidney–pancreas recipients transplanted between 1995 and 2005 were analysed in this retrospective single-centre study. Risk factors for CVE, e.g. recipient and donor age and gender, diagnosis of chronic kidney disease, end-stage renal disease (ESRD) duration, histories of hypertension, hyperlipidaemia, smoking, atrial fibrillation (AF), diabetes mellitus (DM), ischaemic heart, peripheral- and cerebro-vascular disease, as well as pre-transplant myocardial infarction or CVE (i.e. TIA/strokes) were analysed. Furthermore, the predictive value of pre-transplant screening tests, i.e. echocardiography (n = 1184) and carotid ultrasound (n = 922), was investigated.
Results. During a median follow-up of 4 years, 64 CVE (54 strokes and 10 TIA) were observed. Nineteen (5.1%) of 373 deceased patients died from fatal stroke. Recipient age, history of AF and hyperlipidaemia (P = 0.00, respectively), reduced left ventricular function (LVF) (P = 0.01) and the degree of stenosis by carotid ultrasound (P = 0.002), duration of ESRD (P = 0.03) and interstitial nephritis as renal disease cause (P = 0.04) evolved as predictors of TIA/stroke post-transplant in univariate analysis. In multivariable analysis, AF (P = 0.001) and DM (P = 0.037) were significant predictors for post-transplant CVE.
Conclusions. AF and DM are independent predictors of CVE after KTx. Beyond their general ability to detect sev- erely comorbid patients, pre-transplant screening tests (e.g. carotid ultrasound or echocardiography) were not able to identify renal transplant candidates at risk for CVE after transplantation.
Keywords: atrial fibrillation; left ventricular function; outcome; renal transplantation; stroke
Received for publication: 7. 8.07
Accepted in revised form: 1.10.07
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