CAROTID ATHEROSCLEROSIS IN RENAL-TRANSPLANT RECIPIENTS

Background. Cardiovascular accidents are the major cause of morbidity and mortality in renal transplant recipients. However, there is little information concerning carotid atheroscleroric wall changes in renal transplant recipients, their relationship with cardiovascular accident s and their possible association with cardiovascular risk factors in s uch patients. Methods. Between April 1991 and December 1997, we prospe ctively assessed cardiovascular accidents in 79 renal transplant recip ients who had received a transplant at our institution before January 1, 1986. Carotid morphology by B-mode ultrasonography, relevant clinic al and laboratory cardiovascular risk factors, including lipid abnorma lities and total homocyst(e)ine, were determined at the start of the f ollow-up period. Seventeen healthy subjects matched for age and sex wi th renal transplant recipients served as controls who volunteered for ultrasonographic examination of carotid arteries. Results. Nine patien ts experienced cardiovascular events during the period of follow-up. C ompared with healthy, age- and sex-matched control subjects (n= 17), t he frequency of carotid plaques was higher in renal transplant recipie nts with cardiovascular events (n=9), but not in those without such ev ents (n=70). The frequency of cardiovascular accidents was related to the number of carotid plaques (4, 17 and 24% for no plaque, one plaque and >1 plaque respectively, P<0.04). However, by multivariate analysi s, serum total cholesterol [odds ratio (OR) of 1.8 for each 1.0 mM, P < 0.07) and the presence of diabetes mellitus (OR of 28.4 for presence , P<0.01) were the only predictors of cardiovascular events in such pa tients, whereas the presence of carotid plaques was not. Moreover, nei ther serum lipoprotein (a) nor total homocyst(e)ine concentrations cou ld be identified as risk factors. Conclusions. This prospective study shows that although a close association exists between asymptomatic ca rotid atherosclerosis and cardiovascular accidents in renal transplant recipients with long-term follow-up and relatively good renal functio n, other potentially modifiable risk factors appear to be better predi ctors of cardiovascular events. Consequently, the assessment of caroti d atherosclerosis may not be clinically useful for the systematic iden tification of renal transplant recipients with an increased risk of de veloping cardiovascular events.