Although cardiovascular disease is known to be one of the leading causes of death after kidney transplantation (KT), evidence on the risk difference of de novo major adverse cardiovascular event (MACE) in kidney transplant recipients (KTRs) compared to that in dialysis patients or the general population (GP) remains rare.
We identified KTRs using the nationwide health insurance database in South Korea and then 1:1 matched them with the dialysis and GP controls without pre-existing MACE. The primary endpoint was defined as de novo MACEs consisted of myocardial infarction, coronary revascularization, and ischemic stroke. The secondary endpoint was all-cause mortality and death-censored graft failure (DCGF) in KTRs.
We included 4156 individuals in every three groups and followed up them for 4.7 years. De novo MACEs occurred in 3.7, 21.7, and 2.5 individuals per 1000 person-years in the KTRs, dialysis controls, and GP controls, respectively. KTRs showed a lower MACE risk (adjusted hazard ratio (aHR) 0.16, 95% confidence interval (CI) 0.12-0.20, p < 0.001) than dialysis controls, whereas a similar to GP controls (aHR 0.81, 95% CI 0.52-1.27, p = 0.365). In addition, KTRs showed similar MACE risk compared to GP groups, regardless of age, sex, the presence of comorbidities including hypertension, diabetes, and dyslipidemia. Among KTRs, de novo MACE was associated with an increased risk of all-cause mortality, but not with DCGF.
De novo MACE in KTRs was much lower than dialysis patients and even similar risk to the GP, while once it occurred it affected elevated mortality risk in KTRs.

© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.