Trends,Characteristics,and Outcomes of Percutaneous Coronary Intervention Among Kidney Transplant Recipients

Abstract

Kidney transplant recipients (KTRs) face high cardiovascular risk, yet outcomes after percutaneous coronary intervention (PCI) remain poorly characterized. We compared in-hospital outcomes, temporal trends, and predictors of mortality between KTRs and non-transplant patients undergoing PCI. Using the National Inpatient Sample (2016-2021), we identified adult PCI hospitalizations and classified them as KTRs or non-transplant patients. Outcomes included in-hospital mortality, acute kidney injury (AKI), bleeding, length of stay (LOS), and hospitalization costs. Propensity-score matching (PSM) reduced baseline differences, and multivariable logistic regression identified mortality predictors among KTRs. Of 2 677 410 PCI hospitalizations, 8300 involved KTRs. KTRs were younger but had higher comorbidity burden. Unadjusted mortality was higher in KTRs (3.55% vs 2.98%), but not after matching (PSM odds ratio [OR] 0.89; 95% CI, 0.67-1.20). KTRs had higher AKI risk (25.7% vs 16.1%; PSM OR 1.25; 95% CI, 1.10-1.42), whereas AKI requiring dialysis did not differ. Excess bleeding and transfusion in unadjusted analyses were attenuated after matching. KTRs had longer LOS and higher costs. Despite similar in-hospital mortality, KTRs undergoing PCI experience greater AKI risk and resource use, supporting tailored risk stratification and post-procedural monitoring in this population.