Risks of cardiovascular disease and cerebrovascular disease following kidney transplantation: A nationwide, population-based cohort study

<b>Background:</b> Kidney transplant recipients (KTRs) have an increased risk for cardiovascular disease (CVD) and cerebrovascular disease (CBD). This study investigated the risks of CVD and CBD following kidney transplantation. <b>Materials and methods:</b> This retrospective cohort study enrolled 3596 KTRs between 2003 and 2017. Propensity Score Matching (PSM) was performed to select patients without a kidney transplant, who were assigned to the control group. Each KTR was matched with five patients without a kidney transplant by sex, age, insured salary, urbanization level, Charlson comorbidity index (CCI), and year of inclusion in the study. A Cox proportional hazards model was employed to investigate the risks of incident CVD and CBD in KTRs after adjusting for relevant variables. Furthermore, we analyzed for CVD and CBD risk 6 months and 1, 3, and 5 years after transplantation. <b>Results:</b> Among KTRs, the CVD incidence rate per 1,000 person-years was 33.98, which was significantly higher than that among patients without a kidney transplant. After adjusting for confounding variables, KTRs had a significantly higher risk of CVD (adjusted hazard ratio [aHR], 1.74; 95% confidence interval [CI], 1.58-1.93) than did patients without a kidney transplant. Regarding cumulative incidence, the risk of CVD increased over time. Among the four follow-up periods we assessed, the 5-year follow-up period had the highest CVD risk (aHR, 1.35; 95% CI, 1.17-1.56), followed by the 3-year follow-up period (aHR, 1.34; 95% CI, 1.13-1.59). KTRs also had a significantly higher risk of CBD (aHR, 1.43; 95% CI, 1.23-1.68) than did patients without a kidney transplant. <b>Conclusion:</b> CVD risk is higher among KTRs than among those without a kidney transplant, and this risk increases over time. CBD risk was also higher among KTRs. Large, randomized controlled prospective studies are needed to thoroughly evaluate the relationship between kidney transplantation and the risks of CVD and CBD.