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Observational Study
. 2022 Sep 1;29(9):1393-1408.
doi: 10.5551/jat.63189. Epub 2021 Nov 12.

Characteristics and Prognosis of Stroke in Living Donor Renal Transplant Recipients

Takafumi Mizuno  1 , Takao Hoshino  1 , Kentaro Ishizuka  1 , Sono Toi  1 , Ayako Nishimura  1 , Shuntaro Takahashi  1 , Sho Wako  1 , Kazuo Kitagawa  1
Affiliations
Observational Study

Characteristics and Prognosis of Stroke in Living Donor Renal Transplant Recipients

Takafumi Mizuno et al. J Atheroscler Thromb. .

Abstract

Aims: We aimed to determine the characteristics and vascular outcomes of stroke in renal transplant (RT) recipients and compare them with those in patients on hemodialysis (HD) and those with no renal replacement therapy (RRT).

Methods: In this prospective observational study, 717 patients (mean age, 70.8 years; male, 60.5%) with acute ischemic stroke within one week of onset were consecutively enrolled and followed for one year. The patients were classified into three groups: (1) living donor RT recipients (n=27); (2) patients on maintenance HD before the index stroke (n=39); and (3) those with no history of RRT (n=651). The primary outcome was a composite of major adverse cardiovascular events (MACE).

Results: Diabetic nephropathy was the most common reason for RRT in both RT and HD patients. RT patients were more likely to have embolic stroke of undetermined source (33.3%) than others, whereas HD patients more often had cardioembolism (51.3%). No difference was observed in the MACE risk between the patients in RT and non-RRT groups (annual rate, 11.3% vs. 13.1%; log-rank P=0.82; hazard ratio [95% confidence interval], 0.92 [0.29-2.98]). In contrast, HD patients had a greater risk of MACE than those with no RRT (annual rate, 28.2% vs. 13.1%; log-rank P=0.019; hazard ratio [95% confidence interval], 2.24 [1.16-4.3]).

Conclusions: The underlying etiologies of stroke differed in RT and HD patients. The one-year risk of MACE for stroke patients who had received an RT was lower than that for patients undergoing HD and comparable with that of patients with no RRT.

Keywords: Embolic stroke of undetermined source; End stage kidney disease; Hemodialysis; Renal transplantation; Stroke.

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Figures

Supplementary Fig.1.
Supplementary Fig.1.
Study flowchart
Fig.1. Etiologic subtype of ischemic stroke
Fig.1. Etiologic subtype of ischemic stroke
Distributions of etiologic subtype were significantly different between the groups (P=0.031). Abbreviations: ESUS=embolic stroke of undetermined source; RRT=renal replacement therapy.
Supplementary Fig.2. Etiologic subtype of ischemic stroke
Supplementary Fig.2. Etiologic subtype of ischemic stroke
Distributions of etiologic subtype were significantly different between the groups (P=0.002). Abbreviations: CKD=chronic kidney disease; ESUS=embolic stroke of undetermined source; RRT=renal replacement therapy.
Fig.2. Kaplan-Meier curves for major cardiovascular events
Fig.2. Kaplan-Meier curves for major cardiovascular events
Abbreviations: HD=hemodialysis; RRT=renal replacement therapy; RT= renal transplantation.
Supplementary Fig.3. Kaplan-Meier curves for major cardiovascular events
Supplementary Fig.3. Kaplan-Meier curves for major cardiovascular events
Abbreviations: CKD=chronic kidney disease; HD=hemodialysis; RRT=renal replacement therapy; RT=renal transplantation.
Fig.3. Modified Rankin Scale score at one year
Fig.3. Modified Rankin Scale score at one year
Abbreviations: HD=hemodialysis; IQR=interquartile range; mRS=modified Rankin Scale; RRT=renal replacement therapy; RT= renal transplantation.
Supplementary Fig.4. Modified Rankin Scale score at one year
Supplementary Fig.4. Modified Rankin Scale score at one year
Abbreviations: CKD=chronic kidney disease; HD=hemodialysis; IQR=interquartile range; mRS=modified Rankin Scale; RRT=renal replacement therapy; RT=renal transplantation.
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