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. 1976 Sep;184(3):342–351. doi: 10.1097/00000658-197609000-00012

Factors in the differential rate of arteriosclerosis (AS) between long surviving renal transplant recipients and dialysis patients.

F T Thomas, H M Lee
PMCID: PMC1344395  PMID: 786191

Abstract

In this study, the incidence of clinical and autopsy arteriosclerosis (AS) was studied in over 300 renal transplant patients (RTP) followed in our clinic up to 13 years post-transplant. Of 45 RTP followed a mean of 10.45 years, the incidence of clinical AS was 6% or 0.58% per year at risk. The incidence of death from AS was 2.2% over 10 years or 0.22% per year at risk. There was no apparent tendency for increase of the risk incidence with increasing time post-transplantation up to 13 years. This incidence of clinical and death-related AS in long term RTP contrasts sharply with a quite high incidence of both clinical and death-related AS in long-term dialysis patients as reported by Scribner's group and both the European and U.S. Dialysis Registry. Of our RTP surviving a decade or more, 77% have normal serum triglycerides and 92% are normotensive, again contrasting sharply with a 70-80% incidence of hyperlipidemia and a 60-80% incidence of hypertension in long-term dialysis patients. These studies suggest that the high rate of accelerated AS in dialysis patients is largely reversed by successful renal transplantation, probably due to a lowering of both blood pressure and hyperlipidemia in the long-term RT patients. Practically, these results suggest that the superior survival of transplant patients over dialysis patients already evident at 10 year mark will widen further during the second post-transplantation decade.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bagdade J. D., Porte D., Jr, Bierman E. L. Hypertriglyceridemia. A metabolic consequence of chronic renal failure. N Engl J Med. 1968 Jul 25;279(4):181–185. doi: 10.1056/NEJM196807252790403. [DOI] [PubMed] [Google Scholar]
  2. Beaumont J. E., Galla J. H., Luke R. G., Rees E. D., Siegel R. R. Normal serum-lipids in renal-transplant patients. Lancet. 1975 Mar 15;1(7907):599–601. doi: 10.1016/s0140-6736(75)91882-6. [DOI] [PubMed] [Google Scholar]
  3. Burton B. T., Krueger K. K., Bryan F. A., Jr National registry of long-term dialysis patients. JAMA. 1971 Nov 1;218(5):718–722. [PubMed] [Google Scholar]
  4. Casaretto A. A., Marchioro T. L., Bagdade J. D. Hyperlipidemia following renal transplant. Trans Am Soc Artif Intern Organs. 1973;19:154–156. doi: 10.1097/00002480-197301900-00028. [DOI] [PubMed] [Google Scholar]
  5. Casaretto A., Marchioro T. L., Goldsmith R., Bagdade D. Hyperlipidaemia after successful renal transplantation. Lancet. 1974 Mar 23;1(7856):481–484. doi: 10.1016/s0140-6736(74)92787-1. [DOI] [PubMed] [Google Scholar]
  6. Cramp D. G., Moorhead J. F., Wills M. R. Disorders of blood-lipids in renal disease. Lancet. 1975 Mar 22;1(7908):672–673. doi: 10.1016/s0140-6736(75)91770-5. [DOI] [PubMed] [Google Scholar]
  7. Dombeck D. H., Lindholm D. D., Vieira J. A. Lipid metabolism in uremia and the effects of dialysate glucose and oral androgen therapy. Trans Am Soc Artif Intern Organs. 1973;19:150–153. doi: 10.1097/00002480-197301900-00027. [DOI] [PubMed] [Google Scholar]
  8. Hampers C. L., Skillman J. J., Lyons J. H., Olsen J. E., Merrill J. P. A hemodynamic evaluation of bilateral nephrectomy and hemodialysis in hypertensive man. Circulation. 1967 Feb;35(2):272–288. doi: 10.1161/01.cir.35.2.272. [DOI] [PubMed] [Google Scholar]
  9. Hill R. B., Jr, Dahrling B. E., 2nd, Starzl T. E., Rifkind D. Death after transplantation; an analysis of sixty cases. Am J Med. 1967 Mar;42(3):327–334. doi: 10.1016/0002-9343(67)90260-4. [DOI] [PubMed] [Google Scholar]
  10. Hume D. M., Lee H. M., Williams G. M., White H. J., Ferré J., Wolf J. S., Prout G. R., Jr, Slapak M., O'Brien J., Kilpatrick S. J. Comparative results of cadaver and related donor renal homografts in man, and immunologic implications of the outcome of second and paired transplants. Ann Surg. 1966 Sep;164(3):352–397. doi: 10.1097/00000658-196609000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ibels L. S., Stewart J. H., Mahony J. F., Sheil A. G. Deaths from occlusive arterial disease in renal allograft recipients. Br Med J. 1974 Aug 31;3(5930):552–554. doi: 10.1136/bmj.3.5930.552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Linder G. C., Hiller A., Van Slyke D. D. CARBOHYDRATE METABOLISM IN NEPHRITIS. J Clin Invest. 1925 Feb;1(3):247–272. doi: 10.1172/JCI100014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Lindner A., Charra B., Sherrard D. J., Scribner B. H. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med. 1974 Mar 28;290(13):697–701. doi: 10.1056/NEJM197403282901301. [DOI] [PubMed] [Google Scholar]
  14. Lowrie E. G., Lazarus J. M., Hampers C. L., Merrill J. P. Editoral: Cardiovascular disease in dialysis patients. N Engl J Med. 1974 Mar 28;290(13):737–738. doi: 10.1056/NEJM197403282901311. [DOI] [PubMed] [Google Scholar]
  15. Lowrie E. G., Lazarus J. M., Mocelin A. J., Bailey G. L., Hampers C. L., Wilson R. E., Merrill J. P. Survival of patients undergoing chronic hemodialysis and renal transplantation. N Engl J Med. 1973 Apr 26;288(17):863–867. doi: 10.1056/NEJM197304262881701. [DOI] [PubMed] [Google Scholar]
  16. Mahoney C. P., Striker G. E., Hickman R. O., Manning G. B., Marchioro T. L. Renal transplantation for childhood cystinosis. N Engl J Med. 1970 Aug 20;283(8):397–402. doi: 10.1056/NEJM197008202830804. [DOI] [PubMed] [Google Scholar]
  17. Moore T. C., Hume D. M. The period and nature of hazard in clinical renal transplantation. I. The hazard to patient survival. Ann Surg. 1969 Jul;170(1):1–11. doi: 10.1097/00000658-196907000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. O'Brien J. P., Sharpe A. R., Jr The influence of renal disease on the insulin I-131 disappearance curve in man. Metabolism. 1967 Jan;16(1):76–83. doi: 10.1016/0026-0495(67)90161-8. [DOI] [PubMed] [Google Scholar]
  19. PLOTZ C. M., KNOWLTON A. I., RAGAN C. The natural history of Cushing's syndrome. Am J Med. 1952 Nov;13(5):597–614. doi: 10.1016/0002-9343(52)90027-2. [DOI] [PubMed] [Google Scholar]
  20. Parfitt A. M. Soft-tissue calcification in uremia. Arch Intern Med. 1969 Nov;124(5):544–556. [PubMed] [Google Scholar]
  21. Penn I., Starzl T. E. Immunosuppression and cancer. Transplant Proc. 1973 Mar;5(1):943–947. [PMC free article] [PubMed] [Google Scholar]
  22. Ponticelli C., Barbi G., Cantaluppi A., Ceglia E. Letter: Hyperlipidaemia after renal transplantation. Lancet. 1975 May 10;1(7915):1090–1090. doi: 10.1016/s0140-6736(75)91863-2. [DOI] [PubMed] [Google Scholar]
  23. Rosen H., Friedman S. A., Raizner A. E., Gerstmnn K. Azotemic arteriopathy. Am Heart J. 1972 Aug;84(2):250–255. doi: 10.1016/0002-8703(72)90340-7. [DOI] [PubMed] [Google Scholar]
  24. Simmons R. L., Kjellstrand C. M., Buselmeier T. J., Najarian J. S. Renal transplantation in high-risk patients. Arch Surg. 1971 Aug;103(2):290–298. doi: 10.1001/archsurg.1971.01350080206032. [DOI] [PubMed] [Google Scholar]
  25. Starzl T. E., Marchioro T. L., Terasaki P. I., Porter K. A., Faris T. D., Herrmann T. J., Vredevoe D. L., Hutt M. P., Ogden D. A., Waddell W. R. Chronic survival after human renal homotransplantation. Lymphocyte-antigen matching, pathology and influence of thymectomy. Ann Surg. 1965 Oct;162(4):749–787. doi: 10.1097/00000658-196510000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Starzl T. E., Porter K. A., Halgrimson C. G., Husberg B. S., Penn I., Putnam C. W. A decade followup in early cases of renal homotransplantation. Ann Surg. 1974 Oct;180(4):606–616. doi: 10.1097/00000658-197410000-00026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Ulvila J. M., Kennedy J. A., Lamberg J. D., Scribner B. H. Blood pressure in chronic renal failure. Effect of sodium intake and furosemide. JAMA. 1972 Apr 10;220(2):233–238. [PubMed] [Google Scholar]
  28. Vertes V., Cangiano J. L., Berman L. B., Gould A. Hypertension in end-stage renal disease. N Engl J Med. 1969 May 1;280(18):978–981. doi: 10.1056/NEJM196905012801802. [DOI] [PubMed] [Google Scholar]
  29. Wilson R. E., Hampers C. L., Bernstein D. S., Johnson J. W., Merrill J. P. Subtotal parathyroidectomy in chronic renal failure: a seven-year experience in a dialysis and transplant program. Ann Surg. 1971 Oct;174(4):640–654. doi: 10.1097/00000658-197110000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]

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