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Japan Academic Consortium of Kidney Transplantation (JACK).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 was 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 was 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 is needed to reduce late-onset CVD incidence.Katsunori Shimada, PhD. Miyuki Furusawa. Makiko Fujiwara. Kayo Kusubayashi.