EFFECT OF HAVING A FUNCTIONING CADAVERIC RENAL-TRANSPLANT ON CARDIOVASCULAR MORTALITY RISK IN PATIENTS ON RENAL REPLACEMENT THERAPY

Our aim was to estimate the effect of having a functioning cadaveric r enal transplant on the risk of cardiovascular and total mortality in p atients on renal replacement therapy (RRT). We retrospectively studied (by the Cox proportional hazards regression model) 195 subjects who b egan RRT with maintenance dialysis in our centre from 1 January 1978 t o 31 December 1991. Out of this number, 76 patients received a cadaver ic kidney transplant. Cardiovascular abnormalities at the onset of RRT were the principal independent determinant of both total and cardiova scular mortality risk. As compared to patients on dialysis with the sa me duration of RRT, patients with a functioning renal transplant for m ore than 1 year had a significantly lower total mortality risk (mean r elative risk (RR): 0.48 (0.25-0.91) (95% confidence limits in parenthe ses), P=0.03), an effect whose significance disappeared after adjustme nt for pretreatment conditions (RR=0.62 (0.30-1.30), P>0.3). However, the beneficial effect of a functioning renal transplant for more than 1 year on cardiovascular mortality risk was significant, both before ( RR=0.21 (0.06-0.74), P=0.02) and after the adjustment for pretreatment conditions (RR=0.32 (0.11-0.90), P=0.035). During the first year afte r a successful transplantation the beneficial effect of having a funct ioning transplant on cardiovascular mortality risk was only weakly att enuated. During RRT a functioning cadaveric renal transplant decreases cardiovascular mortality risk partially independently of the better p retreatment status of the patients selected for transplantation.