Tsai Tung-Han, Huang Kuang-Hua, Chen Hsin, Gau Shuo-Yan, Su Kun-Yu, Tsai Min-Ling, Lee Chien-Ying
Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
Int J Med Sci. 2025 Apr 13;22(9):2237-2246. doi: 10.7150/ijms.108744. eCollection 2025.
Kidney transplant recipients (KTRs) have an increased risk for cardiovascular disease (CVD) and cerebrovascular disease (CBD). This study investigated the risks of CVD and CBD following kidney transplantation. This retrospective cohort study enrolled 3596 KTRs between 2003 and 2017. Propensity Score Matching (PSM) was performed to select patients without a kidney transplant, who were assigned to the control group. Each KTR was matched with five patients without a kidney transplant by sex, age, insured salary, urbanization level, Charlson comorbidity index (CCI), and year of inclusion in the study. A Cox proportional hazards model was employed to investigate the risks of incident CVD and CBD in KTRs after adjusting for relevant variables. Furthermore, we analyzed for CVD and CBD risk 6 months and 1, 3, and 5 years after transplantation. Among KTRs, the CVD incidence rate per 1,000 person-years was 33.98, which was significantly higher than that among patients without a kidney transplant. After adjusting for confounding variables, KTRs had a significantly higher risk of CVD (adjusted hazard ratio [aHR], 1.74; 95% confidence interval [CI], 1.58-1.93) than did patients without a kidney transplant. Regarding cumulative incidence, the risk of CVD increased over time. Among the four follow-up periods we assessed, the 5-year follow-up period had the highest CVD risk (aHR, 1.35; 95% CI, 1.17-1.56), followed by the 3-year follow-up period (aHR, 1.34; 95% CI, 1.13-1.59). KTRs also had a significantly higher risk of CBD (aHR, 1.43; 95% CI, 1.23-1.68) than did patients without a kidney transplant. CVD risk is higher among KTRs than among those without a kidney transplant, and this risk increases over time. CBD risk was also higher among KTRs. Large, randomized controlled prospective studies are needed to thoroughly evaluate the relationship between kidney transplantation and the risks of CVD and CBD.
肾移植受者（KTRs）患心血管疾病（CVD）和脑血管疾病（CBD）的风险增加。本研究调查了肾移植后发生CVD和CBD的风险。这项回顾性队列研究纳入了2003年至2017年间的3596名KTRs。采用倾向得分匹配（PSM）法选择未进行肾移植的患者作为对照组。根据性别、年龄、参保工资、城市化水平、查尔森合并症指数（CCI）和纳入研究的年份，将每名KTR与五名未进行肾移植的患者进行匹配。采用Cox比例风险模型，在调整相关变量后，研究KTRs发生CVD和CBD的风险。此外，我们分析了移植后6个月以及1、3和5年时的CVD和CBD风险。在KTRs中，每1000人年的CVD发病率为33.98，显著高于未进行肾移植的患者。在调整混杂变量后，KTRs发生CVD的风险（调整后风险比[aHR]，1.74；95%置信区间[CI]，1.58 - 1.93）显著高于未进行肾移植的患者。就累积发病率而言，CVD风险随时间增加。在我们评估的四个随访期内，5年随访期的CVD风险最高（aHR，1.35；95% CI，1.17 - 1.56），其次是3年随访期（aHR，1.34；95% CI，1.13 - 1.59）。KTRs发生CBD的风险（aHR，1.43；95% CI，1.23 - 1.68）也显著高于未进行肾移植的患者。KTRs发生CVD的风险高于未进行肾移植的患者，且这种风险随时间增加。KTRs发生CBD的风险也更高。需要开展大规模、随机对照前瞻性研究，以全面评估肾移植与CVD和CBD风险之间的关系。
