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Published on: June 2, 2022
Coronary artery calcification in renal transplant recipients
Sylvia E Rosas1, Korlei Mensah, Rachel B Weinstein
1Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Sylvia.rosas@uphs.upenn.edu
Insights
Coronary artery calcification (CAC) is common in kidney transplant patients. Early detection of CAC using EBCT can help identify those at higher risk for cardiovascular events post-transplant.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Cardiovascular disease is a primary cause of death in renal transplant recipients.
- Standard pre-transplant cardiac tests may not detect all cases of coronary atherosclerosis.
Purpose of the Study:
- To assess the prevalence and characteristics of coronary artery calcification (CAC) in asymptomatic renal transplant candidates.
- To identify risk factors associated with CAC in this population.
Main Methods:
- Evaluated 79 incident asymptomatic renal transplant recipients.
- Quantified coronary artery calcification (CAC) using Electron Beam Computed Tomography (EBCT).
- Analyzed demographic, clinical, and transplant-related factors associated with CAC presence and severity.
Main Results:
- 65% of patients had detectable CAC.
- Significant univariable associations with CAC included older age, diabetes, dialysis duration, deceased donor transplant, and hypercholesterolemia.
- Age and time on dialysis were independently associated with CAC presence via logistic regression.
Conclusions:
- Coronary artery calcification is highly prevalent in renal transplant recipients.
- CAC assessment may aid in identifying high-risk individuals for cardiovascular events.
- EBCT offers a method for quantifying CAC in this vulnerable patient group.
Abstract:
Cardiovascular disease is the leading cause of mortality in renal transplant recipients. Although renal transplant recipients frequently undergo cardiac functional tests prior to surgery, coronary atherosclerosis can remain undetected. Coronary artery calcification (CAC), an early marker of atherosclerosis can be quantified using EBCT. The purpose of this study was to determine the extent and characteristics of CAC at the time of renal transplantation. We evaluated 79 consecutive incident asymptomatic renal transplant recipients. Patients were mostly White (62%), male (54%) and had a deceased donor renal transplant (61%). The mean age was 47 (12.1) years. Sixty-five percentage of subjects had CAC. The mean CAC score was 331.5 (562.4) with a median of 43.3. Older age, presence of diabetes, not having a preemptive transplant, deceased donor transplantation and hypercholesterolemia were significantly associated with presence of CAC univariately. Median CAC scores were significantly increased in subjects with diabetes (127.8 vs. 28.9, p=0.05), exposed to dialysis (102.9 vs. 3.7, p<0.001) and deceased donor recipients (169.7 vs. 7.5, p=0.02). Using multiple logistic regression, age and time on dialysis were significantly associated with the presence of CAC at the time of transplant. In summary, CAC is prevalent in patients undergoing kidney transplant. CAC may be a method to identify renal transplant recipients at increased risk for future cardiovascular events.
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