Cardiovascular disease is a known determinant of morbidity and mortality in patients undergoing kidney transplantation, which is the commonly chosen treatment for patients with end-stage kidney disease. Researchers for this study sought to examine the rate of major cardiovascular adverse events (MACEs), in the context of an aging transplant population on waitlists, higher diabetic populations and increasing dialysis pre-transplantation, specifically for the perioperative kidney transplantation period.

The study was performed as a retrospective, observational cohort study using the National Inpatient Sample for the period of 2004-2013. All adult patients (18 years or older at the time of admission) were included in the analysis. A total of 147,431 procedures performed in the United States during this time frame were analyzed.

Overall, 6.5%, or 9,592 kidney transplantation patients, experienced perioperative MACEs. Of this group, transplant recipients who experienced a MACE outcome compared to those who did not experience a MACE outcome were:

• Older (55.5 years vs. 49.9 years)
• Diabetics (35.5% versus 23.2%)
• Predominantly male (63.3% male versus 60.1% female)

Upon analysis, Goyal, et al determined that even when factoring in variables such as advancing age of wait-listed kidney transplantation candidates and diabetes, the absolute risk of MACE events after kidney transplantation was low, remaining stable between the evaluation period of 2004-2013.

In addition to this determination, the research team also identified multiple important findings through this analysis:

• Data indicated the most common contributor to MACE after kidney transplantation was heart failure (78% of study subjects) rather than stroke, acute myocardial infarction or other ischemic events (20.96%).

• The study found that despite the growing burden of cardiovascular disease risk factors, including age and diabetes, in kidney transplantation candidates, the overall rates of in-hospital acute myocardial infarction following kidney transplantation remained low and stable over time (most likely a result of heightened awareness of closer management of coronary artery disease).

• Conversely, nontraditional risk factors, including malnutrition (specifically weight loss prior to kidney transplantation completion) and the presence of pulmonary hypertension significantly increased the risk of experiencing perioperative MACE events after kidney transplantation again, because the dominant component of MACE was heart failure.

Thus, risk of heart failure should be a top consideration for patients being considered for kidney transplantation.