Kidney transplant in a asymptomatic high cardiovascular risk patient — a case report and literature overview

Abstract

Cardiovascular complications are the most frequent cause of death of patients with Chronic Kidney Disease (CKD) at each stage of this disease. Cardiovascular risk decreases after kidney transplantation, but it still remains high, with 5% of deaths due to acute coronary syndrome occurring in the first year following kidney transplantation. In the case of CKD patients, cardiovas­cular complications secondary to rapidly progressing atherosclerosis result from both conventional and un­conventional ischaemic heart disease (IHD) risk fac­tors, the latter being conditioned by a specific metabolic nature of this disease. Following kidney transplantation, this risk is increased both by the surgical procedure it­self and an atherogenic activity of immunosuppressive drugs. A well-documented angiospastic effect of calci­neurin inhibitors is also of importance here.

This study discusses a case of a 58-year-old female patient receiving hemodialysis, with G5 stage CKD secondary to diabetic kidney disease, with a history of type 2 diabetes of many years, and many cardiovas­cular complications. The long qualification process for kidney transplantation is analyzed, focusing on its different stages, as well as difficulties during the transplantation procedure and complications after kidney transplantation, resulting in the loss of the graft during one-year follow-up period. Additionally, reports from available studies that suggest a selec­tion of immunosuppressive drugs in high cardio­vascular risk patients are discussed. Complications experienced by the patient following the transplan­tation — myocardial infarction with a sudden car­diac arrest, life-threatening cardiogenic shock, acute transplant rejection, and finally the loss of the graft, serve the authors to discuss benefits and losses in the kidney transplantation qualification process in the case of patients with such complex risk factors.