Assessment of Cardiovascular Risk in Renal Transplant Recipients: Preliminary Results.

BACKGROUND: Cardiovascular (CV) diseases are the most common cause of death in patients with chronic kidney disease, including patients after kidney transplantation. The aim of the study was to do a retrospective analysis of CV risk in renal transplant recipients (RTRs). METHODS: The analysis of CV risk was based on the following scales: QRISK2, Framingham (assessment of development of CV disease), PROCAM (assessment of any CV incident), and Pol-SCORE (assessment of CV death) within a 10-year period. Out of 150 RTRs transplanted in 2007-2009, 100 RTRs (65 male/35 female) with an average age of 48.4 years were enrolled in the study. Coronary heart disease and diabetes mellitus were diagnosed in 7% and 15% of participants, respectively. Coronarography was performed in 38% of patients. Hypertension was diagnosed in 98% of participants, myocardial infarction was diagnosed in 6% of participants, and stroke was diagnosed in 2% of participants. RESULTS: High and very high risk of CV endpoint according to QRISK2, PROCAM, Framingham, and Pol-SCORE scales was found in 41%, 8%, 10%, and 41% of patients, respectively. After 5 years of follow-up, a total of 13 CV events (myocardial infarction and stroke) were observed in 11 patients. Among these patients, the highest risk of endpoint according to QRISK2, PROCAM, Framingham, and Pol-SCORE scales was found in 36%, 9%, 18%, and 45% of patients, respectively. CONCLUSIONS: The QRISK2 and Pol-SCORE scales seem to be the most predictive in assessing CV risk in RTRs.

Cytomegalovirus Status of Kidney Transplant Recipients and Cardiovascular Risk.

BACKGROUND: Cytomegalovirus (CMV) infection is associated with an increased risk of cardiac complications in kidney transplant recipients (KTRs). Some data suggest that CMV may be involved in atherogenesis. The aim of the study was the analysis of CMV medical history in KTRs and its influence on cardiovascular (CV) incidents. MATERIALS AND METHODS: The study observed 254 patients (165 male/89 female) with mean age of 47.2 (range, 15-81) years and duration of dialysis before transplantation 29.2 months who received transplants in 1 university unit (2007-2013). Thirty-six patients were transplanted preemptively. The mean time of observation lasted 7 years. KTRs suffered from diabetes, hypertension, and hyperlipidemia (17.3%, 88.5%, and 61%, respectively). Coronary artery disease was diagnosed in 19.6% patients, 3.5% underwent elective coronary surgery operation, and 9.05% had CV incidents before transplantation. The following CMV donor/recipient (D/R) viral statuses were noticed in the study group: D+/R+ (68.9%), D+/R- (16.9%), D-/R+ (10.2%), and D-/B- (3.9%). D+/R- received universal CMV prophylaxis; the rest were under preemptive CMV prophylaxis. CMV infection affected 87 (34.25%) patients; there were 24 primary infections and 85 secondary infections (some patients had more than 1 CMV). Mean time of diagnosis of the primary and secondary CMV infection was 190.7 and 160.5 days, respectively. RESULTS: During observation 22 patients experienced 26 CV incidents: 15 were D+/R+, 6 were D+/R-, and 1 was D-/R+. CMV infections occurred in 40.9% of patients with CV incidents after kidney transplantation. In comparison, 33.6% patients without CV incidents after kidney transplantation suffered from CMV infection. CONCLUSIONS: CMV infection in KTRs was not a crucial risk factor for CV incidents.

Solid Organ Cancer and Melanoma in Kidney Transplant Recipients: TumorTx Base Preliminary Results.

BACKGROUND: Incidence of malignancy in transplant recipients is higher than in the general population. Malignancy is a major cause of mortality following solid organ transplantation and a major barrier to long-term survival for the kidney. The aim of this study was to estimate the incidence of solid organ malignancy (SOM) and melanoma in renal transplant recipients (RTR) transplanted at 2 representative transplant centers in Poland based on data from the Polish Tumor Registry. MATERIAL AND METHODS: We analyzed the medical data of 3069 patients who underwent kidney transplantation (KTx) between 1995 and 2015. RESULTS: In our study 112 SOM (3.6%) were diagnosed. The majority of patients were male (n = 71; 63.4%; P < .01). The mean age at KTx was 48.0 ± 13.1 years and the mean age at the time of cancer diagnosis was 55.9 ± 12.7 years. The average time of malignancy occurrence was 5.9 ± 5.0 years after KTx. SOM was the cause of death in 60 patients (53%). The most common were malignancies of gastrointestinal tract (25%), urinary tract tumors (23.2%), lung cancer (n = 18; 16%), and lymphoma (13.4%). We found an increase in the percentage of chronic glomerular nephropathy in the group of SOM (n = 56; 50%) compared with renal insufficiency of other etiologies. CONCLUSIONS: RTR in Poland are at a significant risk of malignancy development in a variety of organs, primarily urinary tract tumors and lymphoma. Cancers most frequently occurring in the general population such as lung and colorectal cancer are common in our RTR. On this basis an appropriate tumor screening schedule can be developed in individual countries.

Assessment of cardiovascular risk during peritransplant period in renal transplant recipients.

BACKGROUND: Cardiovascular (CV) diseases are the leading cause of death among patients with chronic kidney disease, including patients on dialysis and after kidney transplantation. The aim of study was the retrospective assessment of CV risk in renal transplant recipients during the peritransplant period. MATERIAL AND METHODS: Evaluation of CV risk was made using the Revised Cardiac Risk Index (RCRI). One hundred kidney transplant recipient (60 males/40 females) participated in the study. In 82 recipients (82%), the RCRI index was 2 points, which was associated with a 6.6% risk of cardiac events. The remaining 18 patients (18%) had ≥3 RCRI points, which was associated with an 11% risk. The median RCRI score in the study group was 2.26, which was related to a risk of 7.39%. RESULTS: In the perioperative period, there were no CV events. The study group was observed for 5 years after transplantation, and during this time, 11 CV incidents occurred. Most of CV incidents occurred during the first 25 months after transplantation. Among patients, who underwent a CV incident, the RCRI was 3 and 2 points in 4 and 5 patients, respectively. Significant correlations were found between RCRI and both age and time spent on dialysis (P < .001). CONCLUSIONS: Patients who qualify for a transplant are at a significant risk of having a CV incident in the peri- and postoperative periods. CV incidents did not occur in the perioperative period, although as many as 6% of patients experienced CV incidents within 2 years after transplant. Four (44%) of the 9 patients who experienced CV incidents after transplantation had a very high RCRI. This indicates the need for a very thorough long-term cardiologic supervision of transplanted patients.