Risk factors for late graft failure and mortality in renal transplantation

PhD ceremony: Mr. A.P.J. Vries, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Title: Risk factors for late graft failure and mortality in renal transplantation

Promotor(s): prof. R.O.B. Gans, prof. W.J. van Son

Faculty: Medical Sciences

Despite all improvements in transplant medicine, renal transplant patients have a high risk for cardiovascular mortality. A measure of heart failure, impaired renal allograft function, and antihypertensive medication, explained the excess risk for cardiovascular mortality to a greater extent than the presence of the metabolic syndrome.

A year after the transplantation, a majority of renal transplant recipients had developed the metabolic syndrome which is a risk factor for cardiovascular disease. The metabolic syndrome was defined as a complex of overweight or obesity, high blood pressure and an unfavourable profile of cholesterol variables. The metabolic syndrome is associated with impaired renal allograft function and increased insulin resistance.

Women suffered more often from post-transplant weight gain and metabolic syndrome than men. Overweight, in particular central obesity, and the immunosuppressant prednisolon were found as most important determinants of insulin resistance. Renal transplant recipients had a 6 to 7 times higher risk of premature mortality as compared to matched controls in the general population. A measure of heart failure, impaired renal allograft function, and antihypertensive medication, explained the cardiovascular risk factors more than the presence of the metabolic syndrome.