Related Experiment Video
Updated: Jul 31, 2026
Non-invasive Imaging of Acute Allograft Rejection after Rat Renal Transplantation Using 18F-FDG PET
Published on: April 28, 2013
Prognostic value of cardiac tests in potential kidney transplant recipients: a systematic review
Louis W Wang1, Philip Masson, Robin M Turner
11 Department of Cardiology, St Vincent's Hospital, Sydney, Australia and St Vincent's Clinical School, University of New South Wales, Australia. 2 Sydney School of Public Health, University of Sydney, Australia. 3 School of Public Health and Community Medicine, University of New South Wales, Australia. 4 Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom. 5 Department of Nephrology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom. 6 Cochrane Renal Group and Centre for Transplant and Kidney Research, Westmead Hospital, Australia.
Insights
Noninvasive cardiac tests, like myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE), are as effective as coronary angiography in predicting cardiovascular events in kidney transplant candidates. However, some patients with normal test results still experience adverse cardiac events.
Area of Science:
- Cardiology
- Nephrology
- Transplant Medicine
- Diagnostic Imaging
- Risk Prediction
Background:
- Preoperative cardiovascular risk assessment is crucial for kidney transplant recipients.
- The predictive value of myocardial perfusion scintigraphy (MPS), dobutamine stress echocardiography (DSE), and coronary angiography for cardiovascular morbidity in this population remains unclear.
Purpose of the Study:
- To assess the performance of MPS, DSE, and coronary angiography in predicting all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE).
- To compare the prognostic accuracy of noninvasive tests versus invasive coronary angiography in potential kidney transplant recipients.
Main Methods:
- A systematic literature search of MEDLINE and EMBASE databases was conducted up to February 2014.
- Studies were appraised, and data were meta-analyzed using random-effects models.
- Risk differences and relative risk ratios (RRR) with 95% confidence intervals (95% CI) were calculated.
Main Results:
- The meta-analysis included 52 studies with 7401 participants.
- Abnormal MPS, DSE, and coronary angiography showed similar rates of MACE (risk difference: 20-24 per 100 patients).
- Noninvasive tests demonstrated comparable predictive accuracy to coronary angiography for cardiovascular mortality and MACE, although coronary angiography showed a trend towards better prediction of all-cause mortality.
Conclusions:
- Noninvasive cardiac testing is as effective as coronary angiography in predicting future cardiovascular events in patients with advanced chronic kidney disease awaiting transplantation.
- A significant proportion of patients with negative test results still experience adverse cardiac events, highlighting the need for comprehensive risk stratification.
Background:
Whether abnormal myocardial perfusion scintigraphy (MPS), dobutamine stress echocardiography (DSE) or coronary angiography, performed during preoperative evaluation for potential kidney transplant recipients, predicts future cardiovascular morbidity is unclear. We assessed test performance for predicting all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACE).
Methods:
We searched MEDLINE and EMBASE (to February 2014), appraised studies, and calculated risk differences and relative risk ratios (RRR) with 95% confidence intervals (95% CI) using random effects meta-analysis.
Results:
Fifty-two studies (7401 participants) contributed data to the meta-analysis. Among the different tests, similar numbers of patients experienced MACE after an abnormal test result compared with a normal result (risk difference: MPS 20 per 100 patients tested [95% CI, 0.11-0.29], DSE 24 [95% CI, 0.10-0.38], and coronary angiography 20 [95% CI, 0.08-0.32; P = 0.91]). Although there was some evidence that coronary angiography was better at predicting all-cause mortality than MPS (RRR, 0.69; 95% CI, 0.49-0.96; P = 0.03) and DSE (RRR, 0.72; 95% CI, 0.50-1.02; P = 0.06), noninvasive tests were as good as coronary angiography at predicting cardiovascular mortality (RRR, MPS, 0.89; 95% CI, 0.38-2.10; P = 0.78; DSE, 1.09; 95% CI, 0.12-10.05; P = 0.93), and MACE (RRR: MPS, 1.09; 95% CI, 0.64-1.86; P = 0.74; DSE, 1.56; 95% CI, 0.71-3.45; P = 0.25).
Conclusions:
Noninvasive tests are as good as coronary angiography at predicting future adverse cardiovascular events in advanced chronic kidney disease. However, a substantial number of people with negative test results go on to experience adverse cardiac events.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention