Cardiovascular complications in renal transplantation.

Cardiovascular disease (CVD) is the leading cause of death following renal transplantation. Its frequency varies as a consequence of such factors as age and the prevalence of CVD in the general population. However, its prevalence is around five times higher than in the general population according to an ERA–EDTA Registry analysis w1x. There are four main categories of CVD, namely, coronary artery disease, cerebrovascular and peripheral vascular disease and left ventricular hypertrophy (LVH) of which numerically the first and last are the most important. With regard to mechanisms, atheroma is the main cause of the vascular disease but other factors also contribute such as vascular calcification. The vascular disease is not a consequence of renal transplantation but rather of the patient’s renal failure although it may be aggravated by post-transplant events. The LVH also precedes, rather than follows, the transplant and there is a tendency to amelioration rather than worsening post-transplant w2x. Our growing understanding of the mechanisms of CVD together with the fact that most patients have been under medical supervision for a considerable length of time prior to the transplant, should give rise to the potential for useful preventative measures. This potential has so far been realized for a number of reasons some of which will be referred to later. With regard to the post-transplant treatment of CVD a similar comment applies namely that we often fail to use the available measures. The single most important reason for this unrealized potential is that our attention tends to be focused too much on the renal allograft to the detriment of trying to resolve accompanying co-morbid disease affecting the patient.