TY - JOUR
T1 - Cardiovascular disease in the kidney transplant recipient
T2 - Epidemiology, diagnosis and management strategies
AU - American Society of Transplantation’s Kidney-Pancreas Community of Practice (AST-KPCOP) Cardiovascular Disease Workgroup
AU - Rangaswami, Janani
AU - Mathew, Roy O.
AU - Parasuraman, Raviprasenna
AU - Tantisattamo, Ekamol
AU - Lubetzky, Michelle
AU - Rao, Swati
AU - Yaqub, Muhammad S.
AU - Birdwell, Kelly A.
AU - Bennett, William
AU - Dalal, Pranav
AU - Kapoor, Rajan
AU - Lerma, Edgar V.
AU - Lerman, Mark
AU - McCormick, Nicole
AU - Bangalore, Sripal
AU - McCullough, Peter A.
AU - Dadhania, Darshana M.
N1 - Publisher Copyright:
© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Kidney transplantation (KT) is the optimal therapy for end-stage kidney disease (ESKD), resulting in significant improvement in survival as well as quality of life when compared with maintenance dialysis. The burden of cardiovascular disease (CVD) in ESKD is reduced after KT; however, it still remains the leading cause of premature patient and allograft loss, as well as a source of significant morbidity and healthcare costs. All major phenotypes of CVD including coronary artery disease, heart failure, valvular heart disease, arrhythmias and pulmonary hypertension are represented in the KT recipient population. Pre-existing risk factors for CVD in the KT recipient are amplified by superimposed cardio-metabolic derangements after transplantation such as the metabolic effects of immunosuppressive regimens, obesity, posttransplant diabetes, hypertension, dyslipidemia and allograft dysfunction. This review summarizes the major risk factors for CVD in KT recipients and describes the individual phenotypes of overt CVD in this population. It highlights gaps in the existing literature to emphasize the need for future studies in those areas and optimize cardiovascular outcomes after KT. Finally, it outlines the need for a joint ‘cardio-nephrology’ clinical care model to ensure continuity, multidisciplinary collaboration and implementation of best clinical practices toward reducing CVD after KT.
AB - Kidney transplantation (KT) is the optimal therapy for end-stage kidney disease (ESKD), resulting in significant improvement in survival as well as quality of life when compared with maintenance dialysis. The burden of cardiovascular disease (CVD) in ESKD is reduced after KT; however, it still remains the leading cause of premature patient and allograft loss, as well as a source of significant morbidity and healthcare costs. All major phenotypes of CVD including coronary artery disease, heart failure, valvular heart disease, arrhythmias and pulmonary hypertension are represented in the KT recipient population. Pre-existing risk factors for CVD in the KT recipient are amplified by superimposed cardio-metabolic derangements after transplantation such as the metabolic effects of immunosuppressive regimens, obesity, posttransplant diabetes, hypertension, dyslipidemia and allograft dysfunction. This review summarizes the major risk factors for CVD in KT recipients and describes the individual phenotypes of overt CVD in this population. It highlights gaps in the existing literature to emphasize the need for future studies in those areas and optimize cardiovascular outcomes after KT. Finally, it outlines the need for a joint ‘cardio-nephrology’ clinical care model to ensure continuity, multidisciplinary collaboration and implementation of best clinical practices toward reducing CVD after KT.
KW - Cardiovascular disease
KW - Chronic kidney disease
KW - Kidney transplantation
KW - Multidisciplinary management
KW - Risk factors
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U2 - 10.1093/ndt/gfz053
DO - 10.1093/ndt/gfz053
M3 - Article
C2 - 30984976
AN - SCOPUS:85065680181
SN - 0931-0509
VL - 34
SP - 760
EP - 773
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 5
ER -