Major Adverse Cardiovascular Events following Simultaneous Pancreas and Kidney Transplantation in the United Kingdom

Petros Yiannoullou, Angela Summers, Shu C Goh, Catherine Fullwood, Hussein Khambalia, Zia Moinuddin, Iestyn Shapey, Josephine Naish, Christopher Miller, Titus Augustine, Martin Rutter, David Van Dellen

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Abstract

Background: People with type-1 diabetes and kidney failure have an increased risk for major adverse cardiovascular events (MACE). Simultaneous pancreas and kidney transplantation (SPKT) improves survival, but the long-term risk for MACE is uncertain.
Methods: We assessed the frequency and risk factors for MACE (defined as fatal cardiovascular disease and non-fatal myocardial infarction or stroke), and related non-fatal MACE to allograft failure in SPKT recipients with type-1 diabetes transplanted between 2001-2015 in the United Kingdom. In a subgroup, we related a pre-transplant cardiovascular risk score to MACE.
Results: During 5 years of follow up, 133/1699 SPKT recipients (7.8%) experienced a MACE. Age (Hazard Ratio [95% CI]: 1.04 [1.01-1.07] per year), prior MI (2.6 [1.3-5.0]), stroke (2.3 [1.2-4.7]), amputation (2.0 [1.02-3.7]), donor history of hypertension (1.8 [1.05-3.2]), and waiting time (1.02 [1.0-1.04] per month) were significant predictors. Non-fatal MACEs predicted subsequent allograft failure (renal: 1.6 [1.06-2.6]; pancreas: 1.7 [1.09-2.6]). In the subgroup, the pre-transplant cardiovascular risk score predicted MACE (1.04 [1.02-1.06] per 1% increment).
Conclusions: We report a high rate of MACE in SPKT recipients. There are a number of variables that predict MACE whilst non-fatal MACE increases the risk of subsequent allograft failure. It may be beneficial that organs from hypertensive donors are matched to recipients with lower cardiovascular risk. Pre-transplant cardiovascular risk scoring may help identify patients who would benefit from risk factor optimisation or alternative transplant therapies, and warrants validation nationally.
Original languageEnglish
JournalDiabetes Care.
Early online date14 Feb 2019
DOIs
Publication statusPublished - 2019

Keywords

  • mortality
  • cardiovascular
  • pancreas
  • kidney
  • transplantation

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