Risk factors and outcome of stroke in renal transplant recipients

Abstract

Stroke incidence is high in end-stage renal disease and risk factors differ between the dialysis and general populations. However, risk factors and outcomes following renal transplantation remain unclear. We analysed all adult patients with a functioning renal transplant from 01/01/2007 to 31/12/2012. Data were extracted from the electronic patient record. Variables associated with stroke were identified by survival analyses; demographic, clinical, imaging and laboratory variables were assessed and case-fatality determined. Follow-up was until 05/12/2013. 956 patients were identified (median age 40.1 years, 59.9% male). Atrial fibrillation prevalence was 9.2% and 38.2% received a transplant during follow-up. 26 (2.7%) experienced a stroke during 4409 patient-years of follow-up (84.6% ischemic). Stroke incidence was 5.96/1000 patient-years. Factors associated with stroke on regression analysis were prior stroke, diabetes, age, systolic hypertension and hemoglobin. Atrial fibrillation was associated with time to stroke (p<0.001).Warfarin did not associate with ischemic stroke risk in those with AF. Fatality was 19.2% at 7, 23.1% at 28 and 42.3% 365 days after stroke. Patients with a functioning renal transplant have a high stroke incidence and case-fatality. Unlike those on hemodialysis, risk factors are similar to the general population. We did not demonstrate benefit from warfarin use in those with AF