Evaluation of solid organ transplant candidates for coronary artery disease

Solid organ transplantation has increased in frequency in the United States, having evolved from an area of experimentation into accepted therapy for end-organ failure. As organ transplantation has become more common, the average age of transplant recipients has increased, thus increasing the potential for multiple comorbidities including coronary artery disease (CAD). CAD has been shown to be a major cause of morbidity and mortality in kidney, lung and liver transplant recipients. Identification of CAD in solid organ transplant candidates allows for stratification of short- and long-term risk, ensuring proper use of valuable allograft resources while guiding further patient management. Assessment of asymptomatic transplant candidates for CAD is difficult. Many patients undergo stress echocardiography or nuclear imaging, which have demonstrated inconsistent rates of sensitivity and specificity for the detection of CAD in these patient populations. Cardiac computed tomography is a potential tool for detecting CAD in these populations, but has questionable utility at this time. Coronary angiography has an important role in detecting CAD in high-risk transplant candidates, affecting their long-term management and risk.