Ischaemic heart disease following renal transplantation

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Abstract
Premature cardiovascular disease is now the leading cause of death in patients with renal transplants [1,2] and, as a consequence, one of the leading causes of renal allograft failure [3]. Thus, better management of cardiovascular disease (CVD) in renal transplant recipients (RTR), should improve both patient and graft survival. However, the management is difficult and, despite the abundant evidence base for the management of CVD in the non-renal population, the available evidence base in RTR is inadequate. The nature of CVD in RTR is also complex, a combination of accelerated atherosclerosis, leading to coronary artery disease, and myocardial disease (particularly left ventricular hypertrophy—LVH) leading to chronic heart failure and sudden arrhythmic death. Moreover, CVD develops from the earliest stages of progressive renal disease and transplant recipients may therefore have advanced coronary artery disease or cardiomyopathy, which may not be reversible. Whether the natural history of CVD in renal transplant recipients can be modified, and how, remains to be established.