Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2015; 5(4): 183-195
Published online Dec 24, 2015. doi: 10.5500/wjt.v5.i4.183
Cardiovascular risk factors following renal transplant
Jill Neale, Alice C Smith
Jill Neale, Alice C Smith, Leicester Kidney Exercise Team, John Walls Renal Unit, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
Jill Neale, Alice C Smith, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 9HN, United Kingdom
Author contributions: Neale J wrote the paper; Smith AC reviewed the paper.
Supported by National Institute for Health Research Diet, Lifestyle and Physical Activity Biomedical Research Unit based at University Hospitals of Leicester and Loughborough University.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: 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/
Correspondence to: Dr. Jill Neale, BSc, MBBS, MRCP, Academic Clinical Fellow, Department of Infection, Immunity and Inflammation, University of Leicester, University Rd, Leicester LE1 9HN, United Kingdom. jn150@student.le.ac.uk
Telephone: +44-116-2584346
Received: June 9, 2015
Peer-review started: June 14, 2015
First decision: August 4, 2015
Revised: August 19, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: December 24, 2015
Processing time: 196 Days and 15.4 Hours
Abstract

Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Non-traditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population.

Keywords: Kidney transplantation; Cardiovascular disease; Atherosclerosis; Immunosuppression; Diabetes mellitus

Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient group. This review identifies the most important risks for CVD and seeks evidence for how they can be most successfully managed and modified to improve morbidity and mortality.