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Prognostic value of cardiovascular screening in potential renal transplant recipients: a single-center prospective
R K Patel1, P B Mark, N Johnston
1Department of Cardiology, Western Infirmary, Glasgow, UK.
Insights
Pretransplant cardiac assessment for kidney transplant candidates identifies risks and impacts survival. However, its effectiveness in identifying and treating coronary artery disease (CAD) remains unclear.
Area of Science:
- Cardiology
- Nephrology
- Transplant Medicine
Background:
- End-stage renal disease (ESRD) patients have high cardiovascular disease (CVD) burden.
- Pretransplant cardiac assessment is crucial for managing ESRD patients awaiting kidney transplantation.
- Evaluating the impact of cardiac screening on transplant outcomes is essential.
Purpose of the Study:
- To assess the outcomes of pretransplant cardiac assessment in ESRD patients.
- To determine the prognostic value of cardiac screening in renal transplant candidates.
- To evaluate the impact of identifying and treating coronary artery disease (CAD) on transplant outcomes.
Main Methods:
- Retrospective analysis of 300 ESRD patients undergoing electrocardiogram, exercise tolerance testing (ETT), and cardiac MRI.
- Coronary angiography and percutaneous coronary intervention (PCI) for patients with high suspicion of CAD.
- Comparison of survival rates between transplanted, listed-not-transplanted, and not-listed patients.
Main Results:
- Successful transplantation improved survival (4.5 years vs. 4.1 vs. 3.1 years; p < 0.001).
- Factors for non-listing included significant cardiovascular disease, poor exercise tolerance, and severe CAD.
- 17 patients (5.6%) underwent PCI; no survival difference was observed between PCI/CABG and angiography-without-intervention groups (p = 0.67).
Conclusions:
- Pretransplant cardiovascular screening provides prognostic information and aids in restricting transplant access.
- The benefit of screening specifically for identifying and treating CAD in this population is not clearly established.
- Further research is needed to clarify the role of CAD intervention in improving renal transplant outcomes.
Abstract:
We assessed the outcome of pretransplant cardiac assessment in a single center. Three hundred patients with end-stage renal disease underwent electrocardiogram, Bruce exercise testing (ETT) and ventricular assessment by cardiac MRI. Patients with high index of suspicion of coronary artery disease (CAD) underwent coronary angiography and percutaneous coronary intervention (PCI) if indicated. Two hundred and twenty-two patients were accepted onto the renal transplant waiting list; 80 patients were transplanted during the follow-up period and 60 died (7 following transplantation). Successful transplantation was associated with improved survival (mean survival 4.5 +/- 0.6 years vs. listed not transplanted 4.1 +/- 1.4 years vs. not listed 3.1 +/- 1.7 years; p < 0.001). Ninety-nine patients underwent coronary angiography; 65 had normal or low-grade CAD and 34 obstructive CAD. Seventeen patients (5.6%) were treated by PCI. There was no apparent survival difference between patients who underwent PCI or coronary artery bypass graft compared to those who underwent angiography without intervention or no angiography (p = 0.67). Factors associated with nonlisting for renal transplantation included burden of preexisting cardiovascular disease, poor exercise tolerance and severity of CAD. Pretransplant cardiovascular screening provides prognostic information and information that can be used to restrict access to transplantation. However, if the aim is to identify and treat CAD, the benefits are far from clear.
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