Non-obstructive coronary angiogram findings prior to kidney transplantation do not predict post-transplant cardiac events.

Abstract

This study aimed to determine the risk factors associated with cardiac events 1 year after transplant in kidney transplant recipients (KTRs). We analyzed the incidence of cardiac events in all KTRs transplanted at our center between 01/2000 and 12/2016, who had non-obstructive cardiac catheterization findings at their pre-transplant evaluation. We identified 141 patients with non-obstructive pre-transplant cardiac catheterization. 83 patients (59%) had cardiac events 1 year after the kidney transplant during a mean follow-up of 7.3 ± 5.3 years. Multivariate Cox regression analysis determined dialysis ≥ 1 year (HR = 2.27, 95% Cl 1.41 - 3.67, p = 0.001), body mass index (BMI) ≥ 35 kg/m2 at time of transplant (HR = 2.24, 95% Cl 1.43 - 3.52, p = 0.0004), tacrolimus trough ≥ 7 ng/mL at 1 year post-transplant (HR = 4.24, 95% Cl 1.95 - 9.22, p = 0.0003), and HBA1-c ≥ 7% at 1 year post-transplant (HR = 1.71, 95% Cl 1.09 - 2.70, p = 0.02) as significant predictors of cardiac events 1 year post-transplant. In unadjusted Kaplan-Meier analysis, any cardiac event post-transplant was associated with a significant risk of death or graft loss (p = 0.02). Dialysis duration, morbid obesity, diabetes control, and tacrolimus levels may represent modifiable risk factors to reduce cardiac events in kidney transplant recipients with non-obstructive cardiac catheterization findings at the time of transplant.