Clinical and Experimental Nephrology

, Volume 22, Issue 3, pp 702–709 | Cite as

Cardiovascular disease in kidney transplant recipients: Japan Academic Consortium of Kidney Transplantation (JACK) cohort study

  • Masayoshi Okumi
  • Yoichi Kakuta
  • Kohei Unagami
  • Ryoichi Maenosono
  • Katsunori Miyake
  • Junpei Iizuka
  • Toshio Takagi
  • Hideki Ishida
  • Kazunari Tanabe
  • The Japan Academic Consortium of Kidney Transplantation
Original article



The number of kidney transplant recipients (KTRs) from diabetic nephropathy (DN) and with cardiovascular disease (CVD) history has increased worldwide. Nevertheless, epidemiologic evidence of CVD in KTRs remains limited.


We investigated post-transplant CVD in 1614 adult KTRs between 1990 and 2014. CVD was defined according to the international classification of diseases (ICD-10). All-cause mortality was also investigated. Final follow-up was performed in March 2016. The KTRs were categorized into four groups according to DN and CVD at surgery.


During the follow-up period, 309 KTRs experienced CVDs and 124 KTRs died. The 15-year cumulative CVDs rate was 87% in KTRs with both DN and CVD history, and the rate in KTRs without those was 22.3%. DN and CVD were associated with increased risk of post-transplant CVD [hazard ratio (HR), 3.44; 95% confidence interval (CI), 2.03–5.82; P < 0.001], and the impact marked increased after 7.5 years follow-up period (HR, 16.56; 95% CI, 6.56–41.8; P < 0.001). DN and CVD in KTRs were associated with mortality (HR, 3.32; 95% CI, 1.34–8.22; P = 0.009), and post-transplant CVD was the leading cause (35.5%) of overall death. However, DN and CVD were not associated with increased graft failure rate.


The risk of post-transplant CVDs incidence in KTRs with DN and CVD history is high, and it increases during the late transplant period. Appropriate routine cardiovascular screening and evaluation are needed to reduce late-onset CVD incidence.


Cardiovascular disease Diabetic nephropathy Epidemiology Kidney transplantation 



We appreciate the support provided by Katsunori Shimada, PhD (STATZ Institute, Inc., Tokyo, Japan), who provided expert assistance with statistical analyses.

Astellas Pharma Inc. (Tokyo, Japan) supported this study with a grant. The sponsor was not involved in the study design, patient enrollment, data collection, analysis, interpretation, or preparation of the manuscript.

JACK Investigators

Participating Centers

Department of Urology, Tokyo Women’s Medical University: Kazunari Tanabe (principal investigator), Hideki Ishida, Masashi Inui, Tomokazu Shimizu, Masayoshi Okumi, Toshihito Hirai, and Daisuke Toki.

Department of Nephrology, Tokyo Women’s Medical University: Kohei Unagami.

Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital: Hiroshi Toma and Kazuya Omoto.

Department of Urology, Ohkubo Hospital: Hiroki Shirakawa.

Transplant Coordinator

Department of Urology, Tokyo Women’s Medical University: Miyuki Furusawa.

Clinical Research Coordinators

Department of Urology, Tokyo Women’s Medical University: Makiko Fujiwara and Kayo Kusubayashi.

Biostatistics and Data Center

Department of Biostatistics, STATZ Institute, Inc., Tokyo, Japan: Katsunori Shimada.

General Management Office

Department of Urology, Tokyo Women’s Medical University: Masayoshi Okumi.

Authors’ contributions

MO performed the research, participated in the data analysis and in writing the manuscript, conducted the research and was responsible for the study’s design. YK participated in the data analysis and revising the manuscript. KU, RM, KM, JI, TT, HI and KT performed the research.

Compliance with ethical standards

The study was carried out according to the principles of the Declaration of Helsinki. This study protocol was approved by the research ethics committee (approval number: 3366-R). Information for the JACK study has been provided in the registration with the University Hospital Medical Information Network (UMIN000018327).

Conflict of interest

None of the authors has any of conflict of interest to declare with regard to the content of this article.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Masayoshi Okumi
    • 1
  • Yoichi Kakuta
    • 1
  • Kohei Unagami
    • 2
  • Ryoichi Maenosono
    • 1
  • Katsunori Miyake
    • 1
  • Junpei Iizuka
    • 1
  • Toshio Takagi
    • 1
  • Hideki Ishida
    • 1
  • Kazunari Tanabe
    • 1
  • The Japan Academic Consortium of Kidney Transplantation
  1. 1.Department of UrologyTokyo Women’s Medical UniversityTokyoJapan
  2. 2.Department of NephrologyTokyo Women’s Medical UniversityTokyoJapan

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