Cardiovascular Complications After Kidney Transplantation
Özet
Cardiovascular disease remains the leading cause of morbidity and mortality in kidney transplant recipients, accounting for 20–30% of all post-transplant deaths and arises from a multifactorial interaction between traditional risk factors — hypertension, dyslipidemia, diabetes mellitus, and smoking — and transplant-specific determinants including immunosuppressive drug toxicity, graft dysfunction, acute rejection, and prolonged pre-transplant dialysis. Immunosuppressive agents drive a distinct pathophysiological cascade — calcineurin inhibitors increase the risk of hypertension and dyslipidemia relative to tacrolimus, corticosteroids promote metabolic syndrome and post-transplant diabetes mellitus, and mTOR inhibitors exacerbate dyslipidemia via PCSK9 upregulation — collectively culminating in accelerated atherosclerosis, coronary artery disease, and de novo heart failure occurring in 10–18% of recipients within 36 months of transplantation. Addressing this burden demands a risk-stratified, multidisciplinary strategy that integrates pretransplant cardiac screening, guideline-directed blood pressure and lipid control, immunosuppression optimisation, and the judicious adoption of emerging cardiorenal therapies — and it is only through dedicated randomised trials in this population that the persistent evidence gap can be closed and the full promise of kidney transplantation realised.
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