Kidney transplant recipients, especially women, have increased risk of cardiovascular mortality

Melanie Wyld

BOSTON — Kidney transplant recipients have a substantially greater risk of cardiovascular mortality than the general population, and excess risk is higher for women than men, according to a speaker at the American Transplant Congress.

“As we all know, patients with end-stage kidney disease have high rates of cardiac death, with those on dialysis having a 10- to 20-times greater risk than the general population,” Melanie Wyld, MBBS, MBA, MPH, of the renal department at Royal Prince Alfred Hospital in Australia, said. “While that does improve after transplant, the rates are still high. In fact, cardiovascular disease is the most common cause of death following transplantation. In the general population, there has been a significant reduction in cardiac mortality due to both primary and secondary prevention efforts, as well as therapeutic interventions. It’s unclear as to whether kidney transplant recipients have seen the same benefits as the general population from these interventions.”

To identify risk factors for cardiovascular death in transplant recipients — as well to compare their cardiovascular mortality with that of the general population — researchers conducted a population-based cohort study of all adult and pediatric transplant recipients in Australia and New Zealand between 1988 and 2013 (n = 17,728). Primary cause of death was determined using ICD-10 codes and data that were prospectively collected from the Australia and New Zealand Dialysis and Transplant Registry and national death registers.

During the study period, 5,286 deaths occurred. Of these deaths, 17.8% were cardiovascular (84% caused by ischemic heart disease).

Researchers found cardiovascular death rates increased with age for both men and women and that risk factors included male sex, age older than 55 years, being on dialysis for more than 36 months, pre-existing coronary artery disease and either diabetes or hypertension as the cause of kidney failure.

In addition, while cardiovascular standardized mortality ratios fell over time from a high of 16.92 in 1984 to 4.03 in 2013, women had a significantly higher relative cardiovascular mortality than men, with women in the 30- to 40-year age group having a risk that was double to men when compared with the general population.

“Women, and in particular young women, do bear the burden of excess cardiac mortality following transplantation and I think that raises the question about what we can do going forward to try to bring that down for our patients,” Wyld said.

She concluded, “Cardiac death rates have fallen more than 40% over the time period we looked at, but contemporary transplant recipients still have a high rate of cardiac death that’s about five-times greater than the general population.” – by Melissa J. Webb

Reference:

Wyld M, et al. Abstract 326. Presented at: American Transplant Congress. June 1-5, 2019; Boston.

Disclosure: Wyld reports no relevant financial disclosures.