Einstein Medical Center, Philadelphia, PA, USA.
Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA.
Nephrol Dial Transplant. 2019 May 1;34(5):760-773. doi: 10.1093/ndt/gfz053.
Kidney transplantation (KT) is the optimal therapy for end-stage kidney disease (ESKD), resulting in significant improvement in survival as well as quality of life when compared with maintenance dialysis. The burden of cardiovascular disease (CVD) in ESKD is reduced after KT; however, it still remains the leading cause of premature patient and allograft loss, as well as a source of significant morbidity and healthcare costs. All major phenotypes of CVD including coronary artery disease, heart failure, valvular heart disease, arrhythmias and pulmonary hypertension are represented in the KT recipient population. Pre-existing risk factors for CVD in the KT recipient are amplified by superimposed cardio-metabolic derangements after transplantation such as the metabolic effects of immunosuppressive regimens, obesity, posttransplant diabetes, hypertension, dyslipidemia and allograft dysfunction. This review summarizes the major risk factors for CVD in KT recipients and describes the individual phenotypes of overt CVD in this population. It highlights gaps in the existing literature to emphasize the need for future studies in those areas and optimize cardiovascular outcomes after KT. Finally, it outlines the need for a joint 'cardio-nephrology' clinical care model to ensure continuity, multidisciplinary collaboration and implementation of best clinical practices toward reducing CVD after KT.
肾移植（KT）是治疗终末期肾病（ESKD）的最佳疗法，与维持性透析相比，它显著提高了患者的生存率和生活质量。KT 后，ESKD 患者的心血管疾病（CVD）负担减轻；然而，它仍然是导致患者和移植物提前丧失、以及产生重大发病率和医疗保健费用的主要原因。所有主要的 CVD 表型，包括冠状动脉疾病、心力衰竭、瓣膜性心脏病、心律失常和肺动脉高压，都在 KT 受者人群中表现出来。KT 受者的 CVD 先前存在的风险因素，在移植后会因代谢紊乱而加剧，如免疫抑制方案的代谢效应、肥胖、移植后糖尿病、高血压、血脂异常和移植物功能障碍。这篇综述总结了 KT 受者 CVD 的主要危险因素，并描述了该人群中明显 CVD 的个体表型。它强调了现有文献中的空白，以强调需要在这些领域进行未来研究，优化 KT 后的心血管结果。最后，它概述了需要一个联合的“心脏肾病学”临床护理模式，以确保连续性、多学科合作和实施最佳临床实践，以减少 KT 后的 CVD。
