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Preoperative Cardiac Risk Assessment in Renal Transplant Recipients: A Single-Center Experience
Kerem Can Yilmaz1, Arzu Neslihan Akgün, Orcun Ciftci
1From the Cardiology Department, Baskent University Faculty of Medicine, Ankara, Turkey.
Insights
Preoperative cardiac risk assessment is crucial for kidney transplant candidates. Patients with multiple risk factors need stress testing, while those with prior cardiovascular disease or diabetes may require direct coronary angiography.
Area of Science:
- Cardiology
- Nephrology
- Transplant Surgery
Background:
- Cardiovascular disease (CVD) is a leading cause of death in patients undergoing renal replacement therapy and kidney transplant recipients.
- Current guidelines lack specific recommendations for preoperative cardiac risk assessment in this unique patient population.
Purpose of the Study:
- To analyze preoperative cardiac test utilization, outcomes, patient characteristics, and the relationship between stress test results and severe coronary artery disease (CAD) in kidney transplant candidates.
- To inform the development of specific cardiac risk assessment strategies for renal transplant recipients.
Main Methods:
- Retrospective analysis of 216 patients undergoing renal transplant between December 2011 and December 2016.
- Inclusion of preoperative echocardiography, exercise stress tests, myocardial perfusion scintigraphy, and coronary angiography data.
- Collection of laboratory values including complete blood cell count, creatinine, lipid profiles, and red cell distribution width.
Main Results:
- Fourteen out of 66 patients (21.2%) exhibited severe coronary artery disease.
- Univariate analysis identified age, family history of CAD, diabetes mellitus, existing CAD, and triglyceride levels as risk factors for severe CAD.
- Multivariate analysis confirmed diabetes mellitus, presence of CAD, and family history of CAD as significant predictors of severe CAD.
Conclusions:
- Renal transplant recipients require tailored cardiac risk assessment protocols.
- Stress testing is recommended for patients with multiple cardiovascular risk factors.
- Patients with prior cardiovascular disease or diabetes mellitus may benefit from direct coronary angiography to rule out severe CAD.
Objectives:
Cardiovascular disease is the major cause of morbidity and mortality in patients on renal replacement therapy and in kidney transplant recipients. There are no specific recommendations for preoperative cardiac risk assessment before renal transplant. The aim of our study was to analyze preoperative cardiac test frequencies, test results, patient characteristics, and relations between cardiac stress test results and severe coronary artery disease.
Materials And Methods:
We retrospectively examined patients who underwent renal transplant between December 2011 and December 2016 in our hospital (Ankara, Turkey). Our study group included 216 patients. All patients had preoperative echocardiography. We recorded results of exercise stress tests, myocardial perfusion scintigraphy, and coronary angiography. For all patients, preoperative complete blood cell count, creatinine, high-density lipoprotein, triglycerides, low-density lipoprotein, and red cell distribution width values were obtained and recorded.
Results:
We classified patient groups according to presence or absence of severe coronary artery disease. Fourteen of 66 patients had severe coronary artery disease. In univariate analyses, age, having a history of familial coronary artery disease, diabetes mellitus, presence of coronary artery disease, and triglyceride levels were risk factors for severe coronary artery disease. In multivariate analysis, diabetes mellitus, presence of coronary artery disease, and having a history of familial coronary artery disease were statistically significant.
Conclusions:
Renal transplant recipients are a special patient population, and there must be specific suggestions for this population. If patients present with more than 1 risk factor, a stress test should be performed to evaluate cardiovascular risk. In some patients, especially those whose risk factors include prior cardiovascular disease or diabetes mellitus, stress tests should be skipped and patients should directly undergo coronary angiography to look for severe coronary artery disease.