Post-kidney transplant modification of cardiovascular risk

Kidney transplantation (KT) offers a survival advantage compared to remaining on dialysis in patients with end stage renal disease. Excellent short-term graft survival is achieved in kidney recipients as a result of improvement in immunosuppressive protocols. Unfortunately, there has been minimal improvement in long-term graft survival mainly due to recipient death from cardiovascular disease (CVD) with a functioning transplant. Both traditional as well as transplant specific risk factors contribute to CVD risk in KT. Graft dysfunction and adverse effects of immunosuppressive agents are the predominant transplant-specific risk factors. Measures to address traditional risk factors as well as modification of immunosuppressive regimens may lower the CVD risk post-KT. General cardio-protective strategies such as lifestyle modifications to minimize weight gain, use of aspirin, aggressive control of dyslipidemia, hypertension, and diabetes need to be optimized in kidney recipients. Evolving protocols with corticosteroid avoidance, calcineurin inhibitor minimization, and use of newer agents such as belatacept have better metabolic risk profile for CVD in kidney recipients. Minimizing time spent on dialysis pre-KT also improves cardiovascular outcomes.