Renal Transplantation and Cardiovascular Risk in ANCA-Associated Vasculitis

Myocardial infarction and ischemic stroke are leading causes of cardiovascular (CV) morbidity and mortality in ANCA-associated vasculitis (AAV), especially for the 20% with end-stage renal disease (ESRD). The researchers assessed the impact of renal transplantation on the risk of myocardial infarction and stroke among patients with ESRD due to ANCA-associated vasculitis (AAV).

The researchers identified patients from the United States Renal Data System with end-stage renal disease (ESRD) due to ANCA-associated vasculitis (AAV) between 2000 and 2016. They examined the association between renal transplantation and the risk of non-fatal and fatal myocardial infarction or ischemic stroke among waitlisted patients using Medicare claims and death data through 2017. They used time-varying Cox proportional hazards models with age as the time scale to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for myocardial infarction and ischemic stroke events among patients who received a renal transplant compared to those who remained on the waitlist.

Results of the Study

• Of 1029 waitlisted patients, 593 (58%) were transplanted over a mean of 5.7 years.
• There were 17 events (4.6/1,000 person-years) in the transplanted group and 40 events (13.7/1,000 person-years) in the group that remained waitlisted.
• A renal transplant was associated with a 78% lower risk of myocardial infarction or ischemic stroke (HR=0.22, 95% CI 0.11 to 0.47).
• These findings persisted across sex and age groups and when censoring patients after living donor transplantation.

Thus, the researchers concluded that among ANCA-associated vasculitis (AAV) patients with end-stage renal disease (ESRD), renal transplantation can substantially reduce the risk of myocardial infarction and ischemic stroke. Improving access to transplantation for this population may further improve outcomes.

Reference

Association of renal transplantation with reduced risk of myocardial infarction and ischemic stroke in ANCA-associated vasculitis: An observational cohort study by Claire Cook et al. published in the Seminars in Arthritis and Rheumatism.

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