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

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.