Modern immunosuppression has expanded access to kidney transplantation by limiting the risk of rejection. However, cardiovascular disease (CVD) remains the principal cause of death with a functioning graft, threatening the long-term survival of transplant recipients. The article reviews the leading risk factors for cardiovascular morbidity both before and after kidney transplantation. Evidence linking poor renal function to CVD is discussed. The function of immunosuppression in exacerbating the risk of both nephrotoxicity and CVD is explored through means of a clinical case study. Underlying kidney disease, hypertension, hyperlipidemia, and diabetes are recognized risk factors for CVD both before and after kidney transplantation. Worsening kidney function and posttransplant immunosuppression exacerbate the risk. Although underlying medical conditions and demographic factors are not easily modifiable, immunosuppression has been recognized as a suitable target. Multiple risk factors converge to increase the risk of cardiovascular events and cardiovascular mortality after kidney transplantation. Clinicians are charged with isolating and treating modifiable risk factors to reduce the risk to long-term survival.
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