Klinisch I - P07 - Predictors of postoperative cardiovascular complications until three months after kidney transplantation

M.C. Slot, J. van de Wetering, M.M.L. Kho, M.G.H. Betjes, J.I. Roodnat

Chair(s): prof. dr. Hans de Frijter, neuroloog, LUMC

Thursday 10 march 2016

13:00 - 13:30h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

Previous studies focused on predictors for long-term cardiovascular complications after renal transplantation. Our aim was to identify factors involved in cardiac events within three months after transplantation.

We conducted a chart review for all renal transplants performed in 2010 and 2011 in our center. Factors included are type and number of transplants, delayed graft function (DGF=need for dialysis after transplantation), previous cardiovascular events, cardiac evaluation on indication according to ESC guidelines: left ventricular ejection fraction (LVEF), cardiac stress test and risk estimation; and postoperative blood loss (decrease in hemoglobin level=∆Hb). A composite end point of any cardiovascular event (ischemia with positive enzymes, myocardial infarction, heart failure, and/or coronary intervention) was used.

354 renal transplants were included, of which 71% were living donation and 83% were first transplants. 58 patients (16%) had had a cardiovascular event before transplantation (myocardial infarction, revascularization and/or heart failure). MIBI scan was performed in 130 patients (48 patients with persistent and/or reversible defects); stress ultrasound in 40 patients (1 with ischemia); exercise in 137 patients (6 with ischemia). In 4 patients, the screening led to cardiac revascularization before transplantation. In 38 transplant patients, a cardiac event occurred; reanimation in 4 patients; acute coronary syndrome in 9 patients (of whom 5 patients underwent intervention); and heart failure in 16 patients. Four patients died within three months after transplantation; 3 patients of cardiac cause. In univariate analysis, type of transplant (living or deceased donor), DGF, age, any cardiovascular event before transplantation, myocardial revascularization, myocardial infarct, MIBI scan, LVEF, and ∆Hb were all significantly associated with cardiac events within three months after transplantation. In multivariate analysis, type of transplant (RR 2.9, p=0.006), pretransplant myocardial infarction (RR 7.9, p<0.001) and abnormal MIBI scan (RR 2.8, p=0.043) remained associated with cardiovascular events within three months after transplantation.

The most vulnerable population for post-transplant cardiovascular events are recipients known with previous myocardial infarction and positive MIBI scan who receive a deceased donor kidney transplantation.