Cardiovascular Complications After Kidney Transplantation
Cardiovascular disease
remains the leading cause of morbidity and mortality in kidney transplant
recipients, accounting for 20–30% of all post-transplant deaths and arises from
a multifactorial interaction between traditional risk factors — hypertension,
dyslipidemia, diabetes mellitus, and smoking — and transplant-specific
determinants including immunosuppressive drug toxicity, graft dysfunction,
acute rejection, and prolonged pre-transplant dialysis. Immunosuppressive
agents drive a distinct pathophysiological cascade — calcineurin inhibitors
increase the risk of hypertension and dyslipidemia relative to tacrolimus,
corticosteroids promote metabolic syndrome and post-transplant diabetes
mellitus, and mTOR inhibitors exacerbate dyslipidemia via PCSK9 upregulation —
collectively culminating in accelerated atherosclerosis, coronary artery
disease, and de novo heart failure occurring in 10–18% of recipients within 36
months of transplantation. Addressing this burden demands a risk-stratified,
multidisciplinary strategy that integrates pretransplant cardiac screening,
guideline-directed blood pressure and lipid control, immunosuppression
optimisation, and the judicious adoption of emerging cardiorenal therapies —
and it is only through dedicated randomised trials in this population that the
persistent evidence gap can be closed and the full promise of kidney
transplantation realised.
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