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Prognostic value of myocardial perfusion imaging in predicting outcome after renal transplantation
Amar D Patel1, Wael S Abo-Auda, Jonathan M Davis
1Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1900 University Boulevard, Birmingham, AL 35294-0006, USA
Insights
Pretransplant stress myocardial perfusion imaging helps identify renal transplant candidates at high risk for cardiac events. Abnormal SPECT scans indicate significantly increased cardiac events, guiding patient screening and management.
Area of Science:
- Nephrology and Cardiology
- Transplant Medicine
- Diagnostic Imaging
Background:
- Cardiovascular disease is a major cause of death post-renal transplantation.
- Pretransplant screening for coronary artery disease (CAD) may improve outcomes in select patients.
- Understanding risk factors for cardiac events is crucial for renal transplant recipients.
Purpose of the Study:
- To evaluate the outcomes of 600 patients undergoing renal transplantation.
- To assess the role of pretransplant stress single-photon emission computed tomographic (SPECT) myocardial perfusion imaging in predicting cardiac events.
Main Methods:
- Prospective collection of outcome data for 600 renal transplant recipients.
- Stress SPECT myocardial perfusion imaging performed pre-surgery in 174 patients.
- Multivariate analysis to identify predictors of cardiac and non-cardiac events.
Main Results:
- Age and diabetes predicted events in patients without pre-SPECT imaging.
- Abnormal SPECT perfusion imaging was the sole predictor of cardiac events in the subgroup studied (p=0.006).
- 42-month cardiac event-free survival was 97% for normal SPECT vs. 85% for abnormal SPECT (RR 5.04).
Conclusions:
- Preoperative stress SPECT imaging is valuable for identifying high-risk renal transplant candidates.
- Abnormal SPECT findings predict significantly higher cardiac event rates post-transplantation.
- These findings support targeted screening and management strategies for renal transplant recipients.
Abstract:
Cardiovascular disease is a significant cause of morbidity and mortality after renal transplantation. Pretransplant screening in a subset of these patients for occult coronary artery disease (CAD) may improve outcome. The objective of this study was to examine the outcome of 600 patients after renal transplantation for end-stage renal disease. Prospective outcome data were collected on 600 consecutive patients who had renal transplantation between 1996 and 1998 at our institution at 42 +/- 12 months after surgery. Stress single-photon emission computed tomographic (SPECT) myocardial perfusion imaging was performed in 174 patients before surgery, 136 (78%) of whom had diabetes mellitus. There were a total of 59 events: 17 cardiac deaths, 14 nonfatal myocardial infarctions, and 28 noncardiac deaths. There were 12 cardiac events and 11 noncardiac deaths among those who had SPECT myocardial perfusion imaging. In a multivariate analysis that included important risk factors, age (p = 0.03 and 0.003, respectively) and diabetes (p = 0.02 and 0.005, respectively) were the predictors of total events and cardiac events in patients who did not undergo stress SPECT perfusion imaging. In the subgroup who had stress perfusion imaging, an abnormal perfusion SPECT study was the only predictor of cardiac events (p = 0.006). The 42-month cardiac event-free survival rate was 97% in patients with normal SPECT images and 85% in patients with abnormal SPECT images (RR 5.04, 95% confidence interval 1.4 to 17.6, p = 0.006). Thus, there is a 2.8% event rate per year after renal transplantation, and approximately 50% of these events are noncardiac. In high-risk patients (most of whom had diabetes) with preoperative stress perfusion imaging, those with normal images had significantly lower cardiac events than those with abnormal images. These results have important implications in patient screening and postoperative management.
