Prasad GVR, Bhamidi V. Managing cardiovascular disease risk in South Asian kidney transplant recipients. World J Transplant 2021; 11(6): 147-160 [PMID: 34164291 DOI: 10.5500/wjt.v11.i6.147]
Corresponding Author of This Article
G V Ramesh Prasad, MBBS, PhD, Professor, Kidney Transplant Program, St. Michael's Hospital, 61 Queen Street East, 9th Floor, Toronto M5C 2T2, ON, Canada. ramesh.prasad@unityhealth.to
Research Domain of This Article
Transplantation
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 18, 2021; 11(6): 147-160 Published online Jun 18, 2021. doi: 10.5500/wjt.v11.i6.147
Managing cardiovascular disease risk in South Asian kidney transplant recipients
G V Ramesh Prasad, Vaishnavi Bhamidi
G V Ramesh Prasad, Vaishnavi Bhamidi, Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
Author contributions: Prasad GVR designed the study, critically reviewed and appraised the literature and wrote the paper; Bhamidi V critically reviewed and appraised the literature; Both authors read and approved the final manuscript.
Conflict-of-interest statement: The authors do not have any conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: G V Ramesh Prasad, MBBS, PhD, Professor, Kidney Transplant Program, St. Michael's Hospital, 61 Queen Street East, 9th Floor, Toronto M5C 2T2, ON, Canada. ramesh.prasad@unityhealth.to
Received: February 26, 2021 Peer-review started: February 26, 2021 First decision: March 31, 2021 Revised: April 12, 2021 Accepted: May 22, 2021 Article in press: May 22, 2021 Published online: June 18, 2021 Processing time: 106 Days and 1.1 Hours
Abstract
South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.
Core Tip: South Asian kidney transplant recipients are at higher risk for cardiovascular disease. Aggressive management should begin before transplantation and continue into the post-transplant phase. Each risk factor should be managed individually to reduce cardiovascular risk and improve post-transplant outcomes.
