LONG-TERM CARDIOVASCULAR MORBIDITY AND MORTALITY IN AUTOSOMAL-DOMINANT POLYCYSTIC KIDNEY-DISEASE PATIENTS AFTER RENAL-TRANSPLANTATION

Patients with autosomal dominant polycystic kidney disease (ADPKD) hav e an increased incidence of hypertension and cardiovascular abnormalit ies. In this long-term follow-up study (5.88 years on average), we eva luated cardiovascular disease and patient and graft survival in 101 AD PKD patients and 692 nondiabetic control patients receiving cadaveric renal transplants between March 1967 and April 1991 at the Leiden Univ ersity Hospital. Graft and patient survival was not different between patient groups, using the same immunosuppressive therapy. However, dea th with functioning graft, mainly due to cardiovascular disease, was s ignificantly more frequent in the ADPKD patients than in controls usin g AZA (P<0.01). Multivariate analysis of pretransplant data showed tha t ADPKD patients on AZA therapy demonstrated an elevated age-adjusted relative risk of 2.07 (95% confidence interval [:95% CI]: 1.12-3.80) f or cardiovascular events and 2.88 (95% CI: 1.41-5.90) for cardiovascul ar mortality alone. After adjustment for age, gender, and other cardio vascular risk factors, a relative risk of 2.39 (95% CI: 1.06-5.40) was found. This was 2.87 (95% CI: 1.04-7.93) when cardiovascular mortalit y was the dependent variable. With posttransplant data, the age-adjust ed relative risk for cardiovascular morbidity and mortality in ADPKD p atients using AZA was 2.16 (95% CI: 1.12-4.15) and 2.97 (95% CI: 1.40- 6.27), with only cardiovascular mortality as the dependent variable. A fter adjustment for age, gender, and other cardiovascular risk factors , this was 1.59 (95% CI: 0.64-3.91) and 2.28 (95% CI: 0.79-6.53), resp ectively. With CsA treatment, an elevated risk for cardiovascular morb idity and mortality in ADPKD patients was present, but the correspondi ng 95% CI were wide and include unity, due to the shorter period of fo llow-up (CsA: 3.81+/-2.50 years vs. AZA: 7.28+/-6.74 years). Survival of ADPKD patients using AZA was less in those patients without pretran splant nephrectomy as compared with control patients, but the morbidit y and mortality of pretransplant nephrectomies should be taken into ac count. We conclude that ADPKD patients show a similar graft and patien t survival after renal transplantation as control patients, but they a re especially at risk for cardiovascular disease after renal transplan tation.