51. Pre-transplant predictors of cerebrovascular events after kidney transplantation
- Author
-
Demetrakis Demetriou, Susanne Aull-Watschinger, Antje Habicht, Hermina Konstantin, Bruno Watschinger, Martin Schillinger, and Walter H. Hörl
- Subjects
Male ,medicine.medical_specialty ,Heart disease ,Transient ischaemic attacks ,Postoperative Complications ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Stroke ,Kidney transplantation ,Proportional Hazards Models ,Retrospective Studies ,Transplantation ,business.industry ,Incidence ,Atrial fibrillation ,Middle Aged ,Prognosis ,medicine.disease ,Kidney Transplantation ,Surgery ,Survival Rate ,Echocardiography ,Nephrology ,Austria ,Cardiology ,Kidney Failure, Chronic ,Female ,business ,Follow-Up Studies ,Kidney disease - Abstract
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 2005wereanalysedinthisretrospectivesingle-centrestudy. 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 cerebrovascular 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) andthedegreeofstenosisbycarotidultrasound(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 severely 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.
- Published
- 2007