Title: Metabolic syndrome in post-renal transplantation: its frequency and impact on the occurrence of cardiovascular events and on graft survival

Biography:

Abstract

Introduction:

Metabolic syndrome (MS) is defined by clinical dysfunctions and biochemical abnormalities, which include obesity, hypertension, dyslipidemia, and impaired glucose metabolism. Metabolic complications after renal transplantation (TR) are Frequent and deserve special attention because they represent factors of morbidity and cardiovascular mortality. In addition, it may be responsible for the appearance of proteinuria and worsening of graft function, suggesting a link with chronic kidney disease (CKD).

The aim of our work is to determine the frequency of metabolic syndrome in post-renal transplantation, its risk factors and its impact on cardiovascular morbidity and mortality as well as graft function.

Materiels and methods:

This is a descriptive retrospective study involving 115 patients who received a renal transplant followed within our unit.

Results:

16 cases of metabolic syndrome have been described in our renal transplant patients, which represents an incidence of 14% of all our patients. The mean age was 41.75 years with a sex ratio H / F of 3. 4 patients had a family history of hypertension and 3 diabetes; only 3 patients practiced a regular sport activity.

The initial nephropathy was indeterminate in 81.25%. It was a preemptive graft in 18.75%. The average duration of hemodialysis was 36.9 months.Renal transplantation was predominantly from a living donor in 81% of cases, with an average donor age of 40.8 years.As induction therapy we used a standard ATG protocol or basiluximab, tacrolimus, MMF and prednisone. One patient had delayed recovery of renal function.

During follow-up, 6 patients were overweight during the first year, 2 being obese.Hypertension was the most common factor found in 93.75% of patients, 73% of whom appeared in the 3 months after renal transplantation. Amlodipine was the most used treatment, and the evolution was favorable with good control of blood pressure.6 patients were overweight during the first year post transplantation, compared to 2 cases of obesity, HTA was established in 93.75% of patients, 73% before M3 post TR, treated with amlodipine.81.25% of the patients presented before the end of the first year a dyslipidemia and only 23% treated by the statins. De novo diabetes was described in 18.75% of our patients and 68.75% had hyperglycemia.Eight patients reported a cardiovascular event: 5 cases of compensated hypertensive heart disease, one case of labor angina with stenosis of the stented IVA artery, one case of compensated heart failure, and one case of stenosis of the renal artery.

Regarding renal function, four cases of aggravation of renal function with positive proteinuria have been described with the biopsy puncture of the graft a case of tubular epithelial nonspecific pain.

Discussion and Conclusion:

In our series the association HTA, dyslipidemia and hyperglycemia was the most frequent, 50% of our patients developed a cardiovascular event and 25% worsening of the renal function.Although the small size of our study population does not allow us to extrapolate our results, it would be interesting to stratify our transplant patients according to metabolic complications in order to establish close surveillance for at-risk patients. This would allow us to reduce the occurrence of cardiovascular complications and loss of kidney transplant.