Cardiovascular disease in kidney transplant recipients: Japan Academic Consortium of Kidney Transplantation (JACK) cohort study
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The number of kidney transplant recipients (KTRs) from diabetic nephropathy (DN) and with cardiovascular disease (CVD) history has increased worldwide. Nevertheless, epidemiologic evidence of CVD in KTRs remains limited.
We investigated post-transplant CVD in 1614 adult KTRs between 1990 and 2014. CVD was defined according to the international classification of diseases (ICD-10). All-cause mortality was also investigated. Final follow-up was performed in March 2016. The KTRs were categorized into four groups according to DN and CVD at surgery.
During the follow-up period, 309 KTRs experienced CVDs and 124 KTRs died. The 15-year cumulative CVDs rate was 87% in KTRs with both DN and CVD history, and the rate in KTRs without those was 22.3%. DN and CVD were associated with increased risk of post-transplant CVD [hazard ratio (HR), 3.44; 95% confidence interval (CI), 2.03–5.82; P < 0.001], and the impact marked increased after 7.5 years follow-up period (HR, 16.56; 95% CI, 6.56–41.8; P < 0.001). DN and CVD in KTRs were associated with mortality (HR, 3.32; 95% CI, 1.34–8.22; P = 0.009), and post-transplant CVD was the leading cause (35.5%) of overall death. However, DN and CVD were not associated with increased graft failure rate.
The risk of post-transplant CVDs incidence in KTRs with DN and CVD history is high, and it increases during the late transplant period. Appropriate routine cardiovascular screening and evaluation are needed to reduce late-onset CVD incidence.
KeywordsCardiovascular disease Diabetic nephropathy Epidemiology Kidney transplantation
We appreciate the support provided by Katsunori Shimada, PhD (STATZ Institute, Inc., Tokyo, Japan), who provided expert assistance with statistical analyses.
Astellas Pharma Inc. (Tokyo, Japan) supported this study with a grant. The sponsor was not involved in the study design, patient enrollment, data collection, analysis, interpretation, or preparation of the manuscript.
Department of Urology, Tokyo Women’s Medical University: Kazunari Tanabe (principal investigator), Hideki Ishida, Masashi Inui, Tomokazu Shimizu, Masayoshi Okumi, Toshihito Hirai, and Daisuke Toki.
Department of Nephrology, Tokyo Women’s Medical University: Kohei Unagami.
Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital: Hiroshi Toma and Kazuya Omoto.
Department of Urology, Ohkubo Hospital: Hiroki Shirakawa.
Department of Urology, Tokyo Women’s Medical University: Miyuki Furusawa.
Clinical Research Coordinators
Department of Urology, Tokyo Women’s Medical University: Makiko Fujiwara and Kayo Kusubayashi.
Biostatistics and Data Center
Department of Biostatistics, STATZ Institute, Inc., Tokyo, Japan: Katsunori Shimada.
General Management Office
Department of Urology, Tokyo Women’s Medical University: Masayoshi Okumi.
MO performed the research, participated in the data analysis and in writing the manuscript, conducted the research and was responsible for the study’s design. YK participated in the data analysis and revising the manuscript. KU, RM, KM, JI, TT, HI and KT performed the research.
Compliance with ethical standards
The study was carried out according to the principles of the Declaration of Helsinki. This study protocol was approved by the research ethics committee (approval number: 3366-R). Information for the JACK study has been provided in the registration with the University Hospital Medical Information Network (UMIN000018327).
Conflict of interest
None of the authors has any of conflict of interest to declare with regard to the content of this article.
Informed consent was obtained from all individual participants included in the study.
- 7.Kidney Disease: Improving Global Outcomes Transplant Work G. KDIGO. clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9(Suppl 3):S1–155.Google Scholar
- 18.Goodkin DA, Bragg-Gresham JL, Koenig KG, Wolfe RA, Akiba T, Andreucci VE, et al. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003;14(12):3270–7.CrossRefPubMedGoogle Scholar
- 20.Lentine KL, Costa SP, Weir MR, Robb JF, Fleisher LA, Kasiske BL, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation. Circulation. 2012;126(5):617–63.CrossRefPubMedGoogle Scholar
- 24.Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108(17):2154–69.CrossRefPubMedGoogle Scholar
- 25.Minami Y, Kajimoto K, Sato N, Hagiwara N, Takano T, Investigators As. End-stage renal disease patients on chronic maintenance hemodialysis in a hospitalized acute heart failure cohort: prevalence, clinical characteristics, therapeutic options, and mortality. Int J Cardiol. 2016;224:267–70.CrossRefPubMedGoogle Scholar