Inflammation, coronary artery calcification and cardiovascular events in incident renal transplant recipients

ObjectiveCoronary artery calcification (CAC) predicts cardiovascular events in the general population. We conducted a prospective study to determine if inflammatory markers were predictive of CAC and if CAC predicted cardiovascular events and mortality in incident renal transplant recipients.MethodsA prospective cohort of 112 asymptomatic incident renal transplant recipients who had no prior history of coronary artery revascularization or myocardial infarction had coronary calcifications measured early post-transplant and at least 18 months later by Agatston score and volume method.ResultsThe mean CAC score was 367.7 (682.3). Inflammatory markers such as WBC and CRP were predictive of CAC severity. Recipients with cardiovascular events (n = 11) or death (n = 12) during the follow-up period had higher mean [675.1 (669.3) vs. 296.8 (669.0), p = 0.02] and median [434.8 vs. 28.9, p = 0.01] CAC score compared to those without them. Recipients with CAC score less than 100 had a better cumulative survival rate compared to the recipients with CAC score greater than 100 [95.1% vs. 82.3%, p = 0.03]. We found a significant unadjusted and adjusted association between CAC score and cardiovascular events and mortality. A quarter (25.9%) of recipients had CAC progression. Coronary calcification progression also predicted cardiovascular events and mortality after adjustment for diabetes and dialysis vintage.ConclusionCAC is prevalent in renal recipients and is predictive of cardiovascular events and mortality. Coronary calcification progression is common and predict clinical outcomes. Inflammatory markers are predictive of CAC severity at time of transplant, but are not predictive of future cardiovascular event or mortality.