Table 3.
Independent clinical correlates of cerebrovascular diagnoses among transplant recipientsa
| Characteristic | Ischemic Stroke (aHR [95% CI]) | Hemorrhagic Stroke (aHR [95% CI]) | TIA (aHR [95% CI]) | Any CVE Diagnosis (aHR [95% CI]) |
|---|---|---|---|---|
| Recipient traits | ||||
| age (yr) | ||||
| 18 to 30 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| 31 to 44 | 1.78 (1.18 to 2.68)c | 0.72 (0.54 to 0.94)d | 1.59 (1.11 to 2.28)c | 1.44 (1.13 to 1.84)c |
| 45 to 60 | 3.82 (2.58 to 5.65)e | 1.00 (Reference) | 3.18 (2.26 to 4.45)e | 2.73 (2.17 to 3.44)e |
| >60 | 6.33 (4.26 to 9.39)e | 1.00 (Reference) | 5.38 (3.83 to 7.57)e | 4.25 (3.36 to 5.37)e |
| female gender | 1.15 (1.01 to 1.32)d | – | 1.25 (1.10 to 1.42)c | 1.20 (1.10 to 1.32)c |
| Hispanic ethnicity | – | – | 0.75 (0.61 to 0.92)c | 0.80 (0.69 to 0.92)c |
| BMI category | ||||
| obese | – | 0.65 (0.46 to 0.92)d | – | – |
| nonobese | – | 1.00 (Reference) | – | – |
| cause of ESRD | ||||
| diabetes | 2.37 (2.03 to 2.77)e | 1.84 (1.41 to 2.40)d | 1.96 (1.72 to 2.24)e | 2.03 (1.83 to 2.26)e |
| hypertension | 1.58 (1.34 to 1.87)e | 1.33 (1.00 to 1.77)d | 1.00 (Reference) | 1.27 (1.13 to 1.43)e |
| other causes | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| dialysis duration before transplantation (mo) | ||||
| 25 to 60 | – | – | 0.87 (0.77 to 0.98)d | – |
| <25 or >60 | – | – | 1.00 (Reference) | – |
| Baseline recipient comorbidities | ||||
| coronary artery disease | 1.36 (1.15 to 1.60)c | 2.07 (1.57 to 2.73)e | 1.30 (1.10 to 1.53)c | 1.37 (1.22 to 1.54)e |
| arrhythmia | 2.18 (1.36 to 3.50)c | – | – | – |
| smoking | 1.46 (1.02 to 2.10)d | – | 1.44 (1.01 to 2.07)d | – |
| Donor traits | ||||
| age (yr) | ||||
| 18 to 30 | – | 1.00 (Reference) | – | 1.00 (Reference) |
| 45 to 59 | – | 1.59 (1.23 to 2.04)c | – | 1.00 (Reference) |
| ≥60 | – | 2.15 (1.56 to 2.97)e | – | 1.27 (1.11 to 1.46)c |
| hypertension | – | – | 1.25 (1.07 to 1.47)c | – |
| Transplantation factors | ||||
| sensitized recipient | 1.47 (1.20 to 1.82)c | – | – | – |
| delayed graft function | 1.17 (0.01 to 1.34)d | – | – | 1.13 (1.02 to 1.24)d |
| allograft failureb | 2.41 (1.98 to 2.93)e | 2.86 (2.12 to 3.86)e | 2.45 (2.04 to 2.93)e | 2.57 (2.26 to 2.94)e |
| Immunosuppression | ||||
| induction therapy | ||||
| any induction versus no induction | 0.86 (0.75 to 0.98)d | – | – | – |
| antithymocyte globulin versus other forms or no induction | – | – | – | 0.85 (0.74 to 0.98)d |
| discharge regimens | ||||
| “nonstandard” regimens | 1.19 (1.02 to 1.39)d | 1.45 (1.23 to 1.86)c | – | – |
Final models determined by Cox regression with stepwise selection. NS categorical strata were collapsed into reference groups by the selection procedure, specifically, BMI categories of underweight, normal, and overweight; ESRD causes of glomerulonephritis, polycystic kidney disease, and others not primarily caused by diabetes or hypertension; pretransplantation dialysis durations of none (preemptive), >0 to 24 mo, and >60 mo; maintenance discharge immunosuppression regimens of CSA and MMF, CSA and azathioprine, tacrolimus and azathioprine or MMF, and rapamycin based. Adjustment covariates considered but not significantly related to any outcome were recipient race, education, congestive heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, and alcohol abuse history; donor type, gender, race, and death as a result of cerebrovascular accident; HLA match; and CMV sero-pairing. aHR, adjusted hazards ratio; CI, confidence interval.
Modeled as a time-varying covariate.
P < 0.01.
P < 0.05.
P < 0.001.