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Review

Coronary artery disease in renal transplant recipients

William E. Braun, MD and Thomas H. Marwick, MD
Cleveland Clinic Journal of Medicine September 1994, 61 (5) 370-385;
William E. Braun
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Thomas H. Marwick
Department of Nephrology and Hypertension (W.E.B.) and the Department of Cardiology (T.H.M.), The Cleveland Clinic Foundation.
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ABSTRACT

BACKGROUND Coronary artery disease is a major cause of death in transplant recipients.

PURPOSE To review current approaches for the detection, evaluation, and treatment of coronary artery disease in transplant recipients.

SUMMARY Renal transplantation promotes the development of coronary artery disease primarily because immunosuppressant medications accentuate known coronary risk factors such as hypertension, hypercholesterolemia, and hyperglycemia that accelerate the progression of coronary artery disease existing before transplantation. Physicians can monitor a patient's risk status by regular inquiries for symptoms and by simple clinical tools such as the Framingham Study Coronary Heart Disease Risk Prediction Chart in asymptomatic patients. Patients found to be at high risk for coronary artery disease can then undergo dobutamine echocardiography or other noninvasive tests, and patients with positive studies can subsequently undergo angiography. The cost-effectiveness of such an approach is presented. In recent studies at our institution, patients with coronary artery disease had decreased numbers of CD2+ and CD3+ circulating lymphocytes. In addition, in immunosuppressed transplant recipients with coronary artery disease, there was a decrease in CD8+ lymphocytes, whereas in nonimmunosuppressed, nontransplant patients there was a decrease in CD4+ lymphocytes.

CONCLUSIONS A systematic approach to screening patients for coronary artery disease before transplantation can identify those at highest risk and potentially save money and lives. Possible new avenues of research may focus on the role of the lymphocytes in coronary atherosclerosis.

INDEX TERMS
  • CORONARY DISEASE
  • KIDNEY TRANSPLANTATION
  • RISK FACTORS
  • Copyright © 1994 The Cleveland Clinic Foundation. All Rights Reserved.
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Cleveland Clinic Journal of Medicine: 61 (5)
Cleveland Clinic Journal of Medicine
Vol. 61, Issue 5
1 Sep 1994
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Coronary artery disease in renal transplant recipients
William E. Braun, Thomas H. Marwick
Cleveland Clinic Journal of Medicine Sep 1994, 61 (5) 370-385;

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Coronary artery disease in renal transplant recipients
William E. Braun, Thomas H. Marwick
Cleveland Clinic Journal of Medicine Sep 1994, 61 (5) 370-385;
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Keywords

  • Coronary Disease
  • KIDNEY TRANSPLANTATION
  • Risk Factors

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