Jeloka Tarun K, Ross Heather, Smith Robert, Huang Michael, Fenton Stanley, Cattran Daniel, Schiff Jeffrey, Cardella Carl, Cole Edward
Renal Transplant Programme, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
Clin Transplant. 2007 Sep-Oct;21(5):609-14. doi: 10.1111/j.1399-0012.2007.00695.x.
Cardiovascular (CV) disease is the foremost cause of mortality and an important cause of morbidity in renal transplant recipients. The disease burden is likely to increase as older patients are accepted for transplantation. The outcome of these high-CV risk patients after renal transplantation, especially with known pre-transplant coronary artery disease (CAD), has not been studied. Hence, we looked at the CV outcome in patients with known pre-transplant CAD.
All renal transplants performed between 1998 and 2002 at our center, followed up to 2005, were divided into high- and low-risk groups, based on the presence of one or more of the following: pre-transplant angina, myocardial infarction, and positive coronary angiogram. The two groups were compared for post-transplant cardiac events and patient and graft survival. The factors predictive of post-transplant cardiac events were also determined by Cox-regression multivariate analysis.
Forty-five patients (10.5%), out of 429, had post-transplant cardiac events; 31.3% in the high risk, and 6.5% in the low-risk group (p = 0.001). Five-yr patient survival was lower in the high-risk group (82.8% vs. 93.1%, p = 0.004), while five-yr overall graft survival and death censored graft survival were statistically not different (74.8% vs. 84.1%, p = 0.08 and 87.3% vs. 90%, p = 0.25). Forty-one percent of patients who were treated with angioplasty plus stenting or bypass graft prior to transplantation had post-transplant cardiac events, as compared with 28% of those without intervention in the high-risk group and 6.5% of patients in the low-risk group (p = 0.001). Age, pre-transplant cardiac disease, arrhythmias, and low-ejection fraction (< or = 40%) were significant independent predictors of post-transplant cardiac events.
Post-transplant survival of high-CV risk patients (with known CAD) is lower than that of low-risk recipients but remains acceptable. Cardiac interventions may reduce perioperative risk but do not reduce the probability of post-transplant cardiac events to that of low-risk group.
心血管（CV）疾病是肾移植受者死亡的首要原因和发病的重要原因。随着年龄较大的患者被接受进行移植，疾病负担可能会增加。这些高CV风险患者肾移植后的结局，尤其是那些已知移植前患有冠状动脉疾病（CAD）的患者，尚未得到研究。因此，我们研究了已知移植前患有CAD的患者的CV结局。
1998年至2002年在我们中心进行的所有肾移植，随访至2005年，根据是否存在以下一种或多种情况分为高风险组和低风险组：移植前心绞痛、心肌梗死和冠状动脉造影阳性。比较两组移植后的心脏事件以及患者和移植物的存活率。还通过Cox回归多变量分析确定了移植后心脏事件的预测因素。
429例患者中有45例（10.5%）发生了移植后心脏事件；高风险组为31.3%，低风险组为6.5%（p = 0.001）。高风险组的5年患者存活率较低（82.8%对93.1%，p = 0.004），而5年总体移植物存活率和死亡截尾移植物存活率在统计学上无差异（74.8%对84.1%，p = 0.08；87.3%对90%，p = 0.25）。移植前接受血管成形术加支架置入或搭桥手术治疗的患者中有41%发生了移植后心脏事件，而高风险组中未接受干预的患者为28%，低风险组患者为6.5%（p = 0.001）。年龄、移植前心脏病、心律失常和低射血分数（≤40%）是移植后心脏事件的重要独立预测因素。
高CV风险患者（已知患有CAD）移植后的存活率低于低风险受者，但仍可接受。心脏干预可能会降低围手术期风险，但不会将移植后心脏事件的发生率降低到低风险组的水平。
