Association of renal transplantation with reduced risk of myocardial infarction and ischemic stroke in ANCA-associated vasculitis: An observational cohort study.

Oct 4, 2021

Contributor: Claire Cook,April Jorge,Xiaoqing Fu,John Niles,Anushya Jeyabalan,Reza Zonozi,John H Stone,Yuqing Zhang,Hyon K Choi,Zachary S Wallace

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). We assessed the impact of renal transplantation on the risk of myocardial infarction and stroke among patients with ESRD due to AAV.
We identified patients from the United States Renal Data System with ESRD due to AAV between 2000 and 2016. We 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. We 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.
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.
Among AAV patients with 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.

Copyright © 2021. Published by Elsevier Inc.

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About The Expert

Claire Cook

Clinical Epidemiology Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

April Jorge

Clinical Epidemiology Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Xiaoqing Fu

Clinical Epidemiology Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

John Niles

Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Anushya Jeyabalan

Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Reza Zonozi

Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

John H Stone

Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Yuqing Zhang

Clinical Epidemiology Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Hyon K Choi

Clinical Epidemiology Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Zachary S Wallace

Clinical Epidemiology Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: zswallace@mgh.harvard.edu.

References

PubMed