Assessment of cardiovascular risk in waiting-listed renal transplant patients: a single center experience in 558...

Area of Science:

• Nephrology
• Cardiology
• Transplantation Medicine

Background:

• Cardiovascular disease poses a significant risk for renal transplant recipients.
• Pre-transplant cardiac screening is crucial for preventing perioperative and long-term cardiovascular mortality.
• An established cardiac assessment algorithm aids in stratifying risk in this patient population.

Purpose of the Study:

• To evaluate the effectiveness of a cardiac assessment algorithm, including dipyridamole-stress sestamibi myocardial scintiscan (DMS), in renal transplant candidates.
• To assess the rates of cardiovascular events and death in relation to DMS findings.
• To determine the optimal follow-up strategy for patients undergoing cardiac screening before renal transplantation.

Main Methods:

• Retrospective observational study of 558 renal transplant candidates.
• Application of a cardiac assessment algorithm, with DMS performed in 54.1% of cases.
• Analysis of DMS results (positive, negative, borderline, necrosis) and subsequent coronary angiography and treatment outcomes.

Main Results:

• DMS was positive in 17.2% of cases; 48.1% of these had treatable coronary lesions.
• No significant difference in cardiovascular events or death was observed between positive and negative DMS groups.
• A substantial proportion (55.9%) of cardiovascular events occurred more than 24 months post-DMS in the negative group.

Conclusions:

• Early detection and management of coronary lesions identified by DMS may mitigate cardiovascular risk in renal transplant candidates.
• The study suggests a need for regular DMS re-evaluation, particularly in patients with initially negative findings, due to late-occurring events.
• A mandatory repeat DMS every two years after a negative finding is recommended to ensure long-term cardiovascular safety.