Clinical Outcomes of Renal Transplant Recipients Undergoing Percutaneous Coronary Intervention

Wayne C. Zheng, Nicole Evans, Diem Dinh, Jason E. Bloom, Angela L. Brennan, Jocasta Ball, Jeffrey Lefkovits, James A. Shaw, Christopher M. Reid, William Chan, Dion Stub

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Abstract

Background: Clinical outcomes of patients with renal transplant (RT) undergoing percutaneous coronary intervention (PCI) remain poorly elucidated. Method: Between 2014 and 2021, data were analysed for the following three groups of patients undergoing PCI enrolled in a multicentre Australian registry: (1) RT recipients (n=226), (2) patients on dialysis (n=992), and (3) chronic kidney disease (CKD) patients (estimated glomerular filtration rate [eGFR], 30‒60 mL/min per 1.73 m2) without previous RT (n=15,534). Primary outcome was 30-day major adverse cardiac and cerebrovascular events (MACCEs)—composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, and stroke. Results: RT recipients were younger than dialysis and patients with CKD (61±10 vs 68±12 vs 78±8.2 years, p<0.001). Patients with RT less frequently had severe left ventricular dysfunction compared with dialysis and CKD groups (6.7% vs 14% and 8.5%); however more, often presented with acute coronary syndrome (58% vs 52% and 48%), especially STEMI (all p<0.001). Patients with RT and CKD had lower rates of 30-day MACCE (4.4% and 6.8% vs 11.6%, p<0.001) than the dialysis group. Three-year survival was similar between RT and CKD groups, however was lower in the dialysis group (80% and 83% vs 60%, p<0.001). After adjustment, dialysis was an independent predictor of 30-day MACCE (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.44‒2.50, p<0.001), however RT was not (OR 0.91, CI 0.42‒1.96, p=0.802). Both RT (hazard ratio [HR] 2.07, CI 1.46‒2.95, p<0.001) and dialysis (HR 1.35, CI 1.02‒1.80, p=0.036) heightened the hazard of long-term mortality. Conclusions: RT recipients have more favourable clinical outcomes following PCI compared with patients on dialysis. However, despite having similar short-term outcomes to patients with CKD, the hazard of long-term mortality is significantly greater for RT recipients.

Original languageEnglish
Pages (from-to)998-1008
Number of pages11
JournalHeart Lung and Circulation
Volume33
Issue number7
DOIs
Publication statusPublished - Jul 2024

Keywords

  • Chronic kidney disease
  • Dialysis
  • Outcomes
  • Percutaneous coronary intervention
  • Renal transplant

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