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Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

Krista L. Lentine^*,, Lisa A. Rocca Rey^*,, Swathy Kolli^*, Giuliana Bacchi^*,, Mark A. Schnitzler^*, Kevin C. Abbott^||, Huiling Xiao^*, and Daniel C. Brennan^¶

^* Center for Outcomes Research and Division of Nephrology, St. Louis University School of Medicine, St. Louis, Missouri; Division of Nephrology, San Paolo Hospital, University of Milan, Milan, Italy; Division of Nephrology, Dialysis and Transplantation, S. Orsola University Hospital, Bologna, Italy; ^|| Nephrology Service, Walter Reed Army Medical Center, Washington, DC; and ^¶ Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri

Correspondence: Dr. Krista L. Lentine, St. Louis University Center for Outcomes Research, Salus Center 2nd Floor, 3545 Lafayette Avenue, St. Louis, MO 63104. Phone: 314-977-9477; Fax: 314-977-1101; E-mail: lentine.krista{at}stanfordalumni.org

Background and objectives: This study examined the risks, predictors, and mortality implications of cerebrovascular disease events after kidney transplantation in a national cohort.

Design, setting, participants, & measurements: This analysis used United States Renal Data System registry data to study retrospectively Medicare-insured kidney transplant candidates (n = 51,504), recipients (n = 29,614), and recipients with allograft failure (n = 2954) in 1995 through 2002. New-onset cerebrovascular disease events including ischemic stroke, hemorrhagic stroke, and transient ischemic attacks were ascertained from billing records, and participants were followed until Medicare-end or December 31, 2002. Multivariable survival analysis was used to compare cerebrovascular disease event incidence and risk profiles among the study samples.

Results: The cumulative, 3-yr incidence of de novo cerebrovascular disease events after transplantation was 6.8% and was lower than adjusted 3-yr estimates of 11.8% on the waiting list and 11.2% after graft loss. In time-dependent regression, transplantation predicted a 34% reduction in subsequent, overall cerebrovascular disease events risk compared with remaining on the waiting list, whereas risk for cerebrovascular disease events increased >150% after graft failure. Similar relationships with transplantation and graft loss were observed for each type of cerebrovascular disease event. Smoking was a potentially preventable correlate of posttransplantation cerebrovascular disease events. Women were not protected. All forms of cerebrovascular disease event diagnoses after transplantation predicted increased mortality.

Conclusions: Along with known benefits for cardiac complications, transplantation with sustained graft function seems to reduce risk for vascular disease events involving the cerebral circulation.