ISCHEMIC-HEART-DISEASE - MAJOR CAUSE OF DEATH AND GRAFT LOSS AFTER RENAL-TRANSPLANTATION IN SCANDINAVIA

Causes of graft loss and death were studied in 1347 recipients of prim ary renal transplants followed for 5 years after transplantation irres pective of graft function, Immunosuppression consisted of high or medi um dose CsA and prednisolone or low dose CsA and prednisolone and azat hioprine, In recipients of cadaver grafts, death with a functioning tr ansplant was more common than graft rejection after the first posttran splant year, accounting for 49% and 41% of the graft losses, respectiv ely, Of deaths with a functioning graft, 53% were due to ischemic hear t disease (IHD) and 10% were due to other vascular disease, In the 55- to 64-year-old age group, the risk of death from IHD was 6.4 times hi gher in the transplanted nondiabetic patients, 8.6 times higher in the dialysis patients (European Dialysis and Transplant Association figur es), and 20.8 times higher in the transplanted diabetic patients than in the general population (national figures), A multivariate Cox regre ssion analysis showed that old age, diabetes mellitus, occurrence of a cute rejection, pretransplant transfusions, delayed onset of graft fun ction, and male gender were significant for death in IHD. We conclude that, in comparison to reports from other regions, Scandinavian renal transplant recipients are at high risk of dying of IHD. Future advance s in long-term renal graft survival will depend largely on the success of preventing myocardial infarction and death in this patient populat ion.