Cardiovascular Risk in Kidney Transplant Recipients After Exposure to Immunosuppression for Treatment of Glomerulonephritis
Bibliographic record
Abstract
Background: Cardiovascular (CV) disease remains the leading cause of morbidity and mortality among kidney transplant recipients. Kidney transplant patients with ESKD from glomerulonephritis (GN) may receive significant pre-transplant immunosuppression (PTI). While immunosuppression is crucial therapy, it may contribute to increased CV risk. The influence of prior immunosuppression on post-transplant CV outcomes remains unexplored. Methods: This retrospective study included adult and pediatric kidney transplant recipients at our institution between January 2005 and March 2020. We included patients with GN as cause of ESKD who received PTI, while the control group included GN patients without PTI and those transplanted for hypertension, polycystic kidney disease, congenital abnormalities of the kidneys and urinary tract, or Alport's syndrome. Patients with diabetes as a cause of ESKD were excluded. The study outcome was major adverse cardiovascular events (MACE) post-transplant, including non-fatal myocardial infarction (MI), non-fatal cerebrovascular accident (CVA), unstable angina (UA), hospitalization for heart failure and cardiovascular death. Results: We identified 763 kidney transplant recipients: 184 had GN with PTI, 147 had GN without PTI, and 432 non-GN patients. Rates of MI, CVA, HF, UA, and mortality were compared among groups (Table). Overall, MACE events were higher in both GN with PTI and GN without PTI groups when compared to the non-GN group. GN with PTI had elevated risk of MACE when compared to the overall control group (21.7% vs 12.6%). Conclusion: Kidney transplant recipients with ESKD due to GN experienced higher rates of MACE and overall mortality compared to non-GN patients. These findings suggest that while higher cumulative immunosuppression burden due to PTI may not be associated with MACE, underlying native disease may have an impact that continues after transplantation. While these are preliminary results with a small population, this study provides a foundation for better understanding how PTI and GNs can independently impact CV risk in kidney transplant recipients. Summary of Major Adverse Cardiovascular Events Post-Transplant - Native Disease (n) MI (n,%) CVA (n,%) HF (n,%) UA (n,%) CV death (n,%) Total MACE (n,%) Mortality (n,%) GN with PTI (184) 11 (5.98) 3 (1.63) 13 (7.07) 6 (3.26) 7 (3.80) 40 (21.74) 35 (19.02) Control GN without PTI (147) 12 (8.16) 9 (6.12) 15 (10.20) 9 (6.12) 3 (2.04) 48 (26.09) 28 (19.05) Other (432) 6 (1.39) 5 (1.16) 9 (2.08) 1 (0.23) 4 (0.93) 25 (5.79) 51 (11.81)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".