Received July 27, 2007
Accepted on February 16, 2008

ORIGINAL ARTICLES

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

Krista L. Lentine ^*1, Lisa A. Rocca ^*, 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

¹ To whom correspondence should be addressed. E-mail: lentine.krista{at}stanfordalumni.org.

	Abstract

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.