MAJOR CARDIOVASCULAR EVENTS AND LENGTH OF KIDNEY TRANSPLANT FUNCTION: A SINGLE CENTER ANALYSIS

A comparison of kidney transplantation (KT) and dialysis reveals that KT is associated with a higher life expectancy. However, cardiovascular (CV) disease, particularly major adverse cardiovascular events (MACE), has been demonstrated to have a significant negative impact on the longevity of kidney transplants due to increased morbidity and mortality in transplant recipients. The objective of this study was to evaluate the relationships between MACE and the length of kidney transplant function (LKTF).

This was a national, single-center, retrospective, longitudinal study. The study included 545 patients who underwent KT between 2008 and 2019.  Patients were monitored until the end of the follow-up period on December 31, 2022. The analysis encompassed both traditional and transplant-specific CV risk factors. MACE was defined as the presence of myocardial infarction, invasive coronary artery therapy, cerebral vascular events, congestive heart failure, rhythm disturbances, or cardiac death. Descriptive statistics were conducted for all study variables. Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACE. A Cox proportional hazard regression model was applied to investigate the influence of covariates on causes of MACE and kidney graft.  Kaplan–Meier estimates were used to describe graft and patient survival.

The mean age at the time of transplantation was 55.0 ± 14.7 years, with a comparable gender distribution between men and women. The mean length of kidney graft function was 87.6 months (SD 39.6). MACE occurred in 145 of 545 (26.6%) KT recipients, with the most prevalent cause being congestive heart failure, followed by coronary heart disease. Cardiovascular disease-related deaths were observed in 6.4% (35 out of 545) of the subjects. According to the univariate analysis, factors significantly related to LKTF at the 0.05 significance level were age, sex, smoking status, graft rejection, hyperuricemia, secondary hyperparathyroidism, treatment with calcineurin inhibitors, and treatment with steroids. The findings from the multiple Cox regression hazards models indicated that the same sociodemographic factors, comorbidities, and treatment types significantly impact the occurrence of MACE. From the socio-demographic factors, men (HR=1.54  [95% CI 1.08; 2.22]) and smokers (HR=1.66 [95% CI 2.40; 2.53])  were at higher risk of MACE. Concerning comorbidities, graft rejection increased the probability of MACE three to seven times according to different models (HR = 5.21 [95% CI 3.47; 7.81]), hyperuricemia increased it two to eight times (HR = 4.38 [95% CI 2.27; 8.46], and secondary hyperparathyroidism 1.1 to three times (HR = 1.89 [95% CI 1.20; 2.98]). Kaplan-Meier analysis of 153-month cumulative graft survival revealed a statistically significant disparity between patients with MACE and those without MACE (56.8% vs. 69.4%, P < 0.001).

MACE has been demonstrated to exert a clinically significant impact on the long-term survival of kidney transplants. To enhance the long-term survival of kidney transplants, it is imperative to identify and treat both traditional and transplant-specific MACE risk factors promptly.