A combination of traditional cardiovascular risk factors and transplant-specifi c vulnerabilities increases the risk for cardiovascular events in renal transplant recipients, underscoring the need for targeted cardiovascular strategies in this patient population, according to results published in Nephrology.

“This study aims to identify key clinical and biochemical predictors of major adverse cardiovascular events (MACE) in this population,” Surjit Tarafdar, MBBS, and colleagues wrote. “Understanding these predictors may improve risk stratifi cation and enhance long-term outcomes for kidney transplant recipients.”
The researchers conducted a systematic literature search of medical databases using PRISMA principles to identify all relevant studies that examined clinical and biochemical parameters in adults with a renal transplant. Fatal or non-fatal cardiovascular events following renal transplantation during hospitalization and for up to 10 years after discharge served as the primary outcomes.

Traditional & Novel Risk Factors

The analysis included 17 peer-reviewed articles with a total of 181,938 renal transplant patients, including 11,090 who experienced adverse cardiac events and 170,848 control patients who did not.

Key novel predictors of MACE identifi ed by Dr. Tarafdar and colleagues included pre-transplant hemodialysis (OR, 2.562; 95% CI, 1.585- 4.139; P<0.001) and delayed graft function (OR, 2.113; 95% CI, 1.397-3.198; P<0.001).

“Importantly, transplant from a living donor (OR, 0.463; 95% CI, 0.393-0.546; P<0.001) was a protective factor,” the researchers noted.

They also found that traditional cardiovascular risk factor profi les all predicted MACE events (P<0.05), including diabetes, age, male gender, peripheral vascular disease, and smoking.

“While traditional risk factors are well known in predicting cardiac events, this study emphasizes two less well-known predictors, delayed graft function and living donor status, which signifi cantly impact cardiac outcomes post-transplant,” the researchers wrote.

Clinical Implications

Findings from the systematic review and meta-analysis highlight several novel predictors of MACE, and the impact of traditional cardiovascular risk factors, in patients who have had a renal transplant, Dr. Tarafdar and colleagues noted.

“Despite improved kidney function, renal transplant recipients remain at an elevated risk for cardiovascular complications and mortality in the setting of these traditional and emerging [cardiovascular] risk factors,” they wrote.

The researchers need further results for targeted cardiovascular risk management in renal transplant recipients.