Epidemiology, risk factors and surgical treatment of ischemic heart disease after kidney transplantation

Ischemic heart disease (IHD) is the major cause of death in renal transplant recipients. The aim of this study was to assess the prevalence, risk factors of IHD, influence of coronary artery disease on late results of renal transplantation and the efficiency of coronary revascularization. We analyzed 479 renal transplant patients (332 males, 147 females, age 38,69 ± 11,2 years). The follow-up period was 64,56 ± 37,44 months after transplantation. Diabetes mellitus was found in 68 recipients. IHD was present in 14,8% of all patients (71 from 479); in 12,7% recipients it was found de novo during 32,4 ± 18 mo after transplantation. 10-year patient survival rate was 39% in IHD group and in 75% in patient without coronary artery disease (p < 0,0001). Age >45 year, gender, diabetes, hyperlipidemia, infections, left ventricular hypertrophy (LVH) and renal transplant dysfunction were defined as risk factors of de novo IHD. Coronary artery disease was independently associated only with age (p < 0,009), gender (p < 0,00001) and hyperlipidemia (p < 0,0058). 36 renal transplant recipients with IHD were undergoing percutaneous transluminal coronary angioplasty (PTCA) with stenting and 2 - coronary artery bypass grafting (CABG). Seven PTCA-treated patients required subsequent revascularization during 3-6 months. Follow-up after revascularization was 23 months (2 to 74). Long-term effect (>12 months) was defined in 71% patients. Two PTCA - treated patients dead after 28 and 35 months from extracardial causes. One recipient dead in consequence of cardiac failure in 78 months after subsequent revascularization when he returned to dialysis therapy. Conclusion: IHD is found in 14,8% of renal transplant recipients and in 12,7% patients it defined de novo . Coronary heart disease is associated with Age >45 year, gender, diabetes, hyperlipidemia, infections, left ventricular hypertrophy and renal transplant dysfunction. Coronary revascularization may be used as effective method of treatment of renal transplant patients with IHD.

Трансплантация почки, ИБС, эпидемиология, факторы риска, хирургическое лечение

1. Ким И.Г., Томилина Н.А., Жидкова Д.А., Остроумов Е.Н., Честухин В.В., Гонтуар М.Г. Кардиоваскулярные осложнения после трансплантации почки. IY Конференция Российского Диализного Общества. Нефрология и диализ 2005; 7; 3: 331.

2. Aakhus S., Wideroe T.E. Cardiovascular morbidity and risk factors in renal transplant recipients. Nephrol Dial Transplant 1999; 14: 648-654.

3. Andrews T., Brickner M., Rutherford J. Ischemic heart disease in end-stage renal failure/ Cardiovascular disease in End-stage Renal Failure. Ed. by Loscalzo J., London G. Oxford 2000: 45-56.

4. Carlstrom J., Norden G., Mjornsstedt L., Nyberg G. Increasing prevalence of cardiovascular disease in kidney transplant patients with type 1 diabetes. Transplant Int 1999; 12: 176-181.

5. Chesser A., Savage T. Diagnosis management of ischemic heart disease in end-stage renal failure/ Cardiovascular disease in End-stage Renal Failure. Ed. by Loscalzo J., London G. Oxford 2000: 317-334.

6. Drueke T., Abdulmassih Z., Lacour B. et al. Atherosclerosis and lipid disorders. after renal transplantation. Kidney Int 1991; 39; Suppl. 31: S24-S28.

7. Frishman W. Biological markers as predictors of cardiovascular disease. JAm Soc Nephrol 1998; 104: S18-S27.

8. Glassberg H., Loscalzo J. Endothelial function in end-stage renal failure/ Cardiovascular disease in End-stage Renal Failure. Ed. by Loscalzo J., London G. Oxford 2000: 117-155.

9. Hjelmesaeth J., Hartman A., Kofstad J. et al. Glucose intolerance after renal transplantation depends upon prednisolone dose and recipients age. Transplantation 1997; 64: 979-983.

10. Kahan B., Ponticelli C. Cardiovascular disease and its causes/ Principals and practice of renal transplantation. London 2000: 589-614.

11. Kasiske B., Guijarro C., Massy Z. et al. Cardiovascular disease after renal transplantation. J Am Soc Nephrol 1996; 7: 158-165.

12. Kasiske B., Chakkera H., Roel J. Explained and unexplained ischemic heart disease risk after renal transplantation. J Am SocNephrol. 2000; 11: 1735-1743.

13. Kobashigawa J., Kasiske B. Hyperlipidemia in solid organ transplantation. Transplantation 1997; 63: 331-338.

14. Lindholm F., AlbrechtsenD., Frodin L. et al. Ischemic heart disease - major cause of death and graft-loss after transplantation in Scandinavia. Transplantation 1995; 60, p 451-457.

15. Ponticelli C., Opelz G. Are corticosteroids really necessary in renal transplantation? Nephrol Dial Transplant 1995; 10: 1587-1591.

16. Raine A., Margreiter R., Brunner F. et al. Report of management of renal failure in Europe XXII, 1992. Nephrol Dial Transplant 1992; 7 (Suppl. 2): 7-35.

17. Raine A., McMahon S., Selwoog N., Wing A., Brunner F. Mortality from myocardial infarction in patients on renal replacement therapy in the UK. Nephrol Dial Transplant 1991; 6: 902.

18. Raine A. Hypertension and ischemic heart disease in renal transplant recipients. Nephrol Dial Transplant 1995; 10 (Suppl. 1): 95-100.

19. Rigatto C., Parfrey Р. Factors governing cardiovascular risk in the patient with a failing renal transplant. Peritoneal Dialysis International 2001; 21, Suppl 3: 275-279.

20. Rigatto C., Parfrey P., London G. Cardiac hypertrophy in end-stage renal failure/ Cardiovascular disease in End-stage Renal Failure. Ed. by Loscalzo J., London G., Oxford 2000; 157-173.

21. Rostand S. Coronary heart disease in chronic renal insufficiency: Some management considerations. J Am Soc Nephrol 2000; 11: 1948-1956.

22. Stewart G., Jardine A., Briggs J. Ишемическая болезнь сердца после трансплантации почки. Нефрология и диализ 2001; 3; 3: 381-389.

23. Sumrany N., Delaney V., Ding Z. et al. Diabetes mellitus after renal transplantation in cyclosporine era. An analysis of risk factors. Transplantation 1991; 51: 343-347.

24. Wheeller D., Baigent C. Cardiovascular risk factors in chronic renal failure / Cardiovascular disease in End-stage Renal Failure. Ed. by Loscalzo J., London G., Oxford 2000; 2-28.

25. Woo Y., Jardine A., Dark A. et al. Early graft function and patient survival following cadaveric renal transplantation. Kidney Int 1999; 55: 692-699.