Renal transplantation delays major adverse cardiac events (MACEs) in patients with end-stage renal disease: A nationwide population-based study

Background: Whether renal transplantation (RT) influences the risk of cardiovascular events remains controversial. Methods: This nationwide population-based study investigated the risk of major adverse cardiac events (MACEs) and stroke after RT in patients with end-stage renal disease (ESRD), using data obtained from the National Health Insurance Research Database in Taiwan. A total of 164 ESRD patients who underwent RT formed the study cohort, and an age- and sex-matched control group comprised 164 patients without RT selected from 6976 ESRD patients. All patients were enrolled between January 1, 2000 and December 31, 2009. Those who developed MACEs and/or stroke during the study period were identified according to the International Classification of Diseases, Ninth Revision, Clinical Modification. A Kaplan–Meier MACEs-free curve was used to compare MACEs episodes between the study and control groups. Results: The mean age was similar between RT and non-RT patients, with most between 30 and 50 years old. In this age range, MACEs developed in 47.5% of the RT group and in 52.5% of the non-RT group (p = 0.0882). The survival rate among all ESRD patients was significant higher in the RT group than in non-RT group (p < 0.001). The MACEs-free, stroke-free and MACEs-or-stroke-free rates were significantly higher in the RT group than in the non-RT group (p = 0.0134, 0.035 and 0.005, respectively) as demonstrated by Kaplan–Meier curves. Conclusion: RT seemed not to reduce the risk of MACEs directly, but it could have dramatically delayed MACEs and stroke episodes in the ESRD patients. Furthermore, a lower mortality rate was observed in the ESRD patients who received RT than in those undergoing chronic dialysis. Further in-depth investigation is necessary to identify other protective factors against MACEs or stroke in ESRD.