Analysis Of Risk Factors And Risk Assessment Of Cardiovascular Events In332Cases Of Renal Transplant Recipients

Objectives:1.To describe the prevalence of cardiovascular events (CVE) and relative risk factors in renal transplant recipients.2.Establish a new model to assess CVE risk in renal transplant recipients.Methed:1.We collected data of renal transplant recipients, who had undergone renal transplantation and had been followed up in our center in2007-2010. We recorded the occurrence of CVE, detected risk factors of CVE, analyse the prevalence of risk factor related to CVE, such as post-transplant hypertension(PTH)、post-transplant diabetes mellitus(PTDM)、post-transplant hyperlipaemia, etc.2.We use binary logistics regression to analyse the risk factors relative to CVE in renal transplant recipients, establish the CVE risk model.Results:1.This study included332renal transplant recipients,239were male and93were female; average age was43.94±9.30years, mean follow-up time were2.54±0.93years, we confirmed21CVE,16(76.2%) were cardiovascular disease(coronary heart disease, myocardial infarction).2.Analysis of CVE risk factors:258developed PTH, the rate was71.7%, the control rate of blood pressure were75.0%; except17patients of pre-transplant diabetes,50developed PTDM, the rate were15.9%;159of patients had post-transplant hyperlipaemia, the rate were47.9%;70of these patients were hypertriglyceridemia, and51patients were hypercholesterolemia,38patients were mixed hyperlipidemia; the number of patients who had proteinuria, abnormal renal function (urea, creatinine) and high uric acid was74(22.3%),152(45.8%) and101(30.4%).287(86.4%) cases of renal transplant recipients receiving hemodialysis before transplantation,242(72.9%) patients were taking FK506.3.The establishment of risk model:the result of univariate analysis showed that the status of BMI, smoking, systolic blood pressure, PTDM, total cholesterol, proteinuria, creatinine, uric acid of renal transplant recipients were relative to CVE; multivariate analysis showed that systolic blood pressure, total cholesterol, creatinine and PTDM can significantly increase the risk of post-transplant CVE(P<0.05). The regression equation:Y=-7.787+0.873X7+0.826X8+1.266X9+1.334X11, predictive accuracy rate was93.1%.4.The compare of different models:the constituent ratio of risk ranking of Framingham risk model and Chinese cardiovascular risk model in CVE group and Non-CVE group were significantly different. The average risk score of CVE group was significantly higher than Non-CVE group. Both of the two model can predict CVE in renal transplant recipients. ROC curve was used to compare the effectiveness of the new model with two models. AUC and Youden index of the new model is higher than the others ones.Conclusions:1.the most common risk factors in renal transplant recipients are PTH post-transplant hyperlipidemia, abnormal renal function, hyperuricemia, proteinuria and PTDM.2.Systolic blood pressure, PTDM, total cholesterol, and creatinine levels after renal transplantation are significantly related to post-transplant CVE. Compared with other models the new model:Y=-7.787+0.873X X7+0.826X X8+1.266X X9+1.334X X11is more effective in the prediction of post-transplant CVE.