Kidney Allograft Recipients With Pre-Transplant History of Stroke Are at Higher Risk of All-Cause, But Not Stroke-Related, Mortality Post-Transplantation.

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Aims. Mortality risk for kidney allograft recipients with pre-existing history of stroke is unknown. We determined risk for all-cause and stroke-related mortality post kidney transplantation in a population-based cohort stratified by diagnosis of pre-existing stroke. Methods. We linked data between two national registries (Hospital Episode Statistics and the Office for National Statistics) to select all mortality events after kidney transplantation in England between April 2001 and March 2012. Primary outcome measure was mortality post-transplantation comparing recipients with versus without pre-transplantation history of stroke. Results. 19,103 kidney allograft recipients were analysed, with 154 (0.8%) recipients known to have had a stroke pre-transplantation. 2085 deaths (10.9%) occurred post-transplantation (median follow up 4.4 years [interquartile range 2.2-7.3 years]). Stroke-related mortality constituted 113 of all deaths post-transplantation (5.4% of total deaths). Patient with history of stroke pre-transplantation were more likely to be older than 65, male, white, diabetic and have previous history of myocardial infarct or peripheral vascular disease. Kidney allograft recipients with versus without a pre-transplant history of stroke had a higher risk of death post-transplantation (21.5% versus 10.8% respectively, p<0.001). However this increased mortality for kidney allograft recipients with pre-transplant history of stroke was not due to increased risk of stroke post-transplantation (with versus without pre-transplant stroke history, 1.6% versus 5.5% of total deaths, p=0.146). Cardiovascular-related mortality between kidney allograft recipients was similar with versus without pre-transplant history of stroke (23.0% versus 21.1% respectively, p=0.417). In a Cox regression model, pre-transplant history of stroke was found to be an independent risk factor predicting all-cause mortality amongst kidney allograft recipients post-transplantation (hazard ratio 1.79, 95% confidence interval 1.28-2.51, p=0.001). Conclusion. All-cause mortality is more common in kidney allograft recipients with pre-exiting history of stroke, but this mortality is not driven by stroke-related events.

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