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Myocardial ischemia by radionuclide imaging and long-term outcomes after kidney transplantation

Sanmay Low1,2, Horng-Ruey Chua3,4, Raymond Wong5,6

  • 1Department of Medicine, Level 10 Medicine Office, National University Centre for Organ Transplantation, National University Hospital, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore.

International Urology and Nephrology
|July 15, 2020
PubMed
Abstract

Insights

Myocardial ischemia (MI) detected early after kidney transplantation in recipients (KTRs) predicts poor long-term outcomes, including mortality and graft loss. Early MI identification is crucial for risk stratification in KTRs.

Area of Science:

  • Cardiology
  • Nephrology
  • Transplantation Medicine

Background:

  • Kidney transplant recipients (KTRs) face significant cardiovascular risks.
  • Early detection of myocardial ischemia (MI) is vital for improving long-term outcomes in KTRs.

Purpose of the Study:

  • To determine the incidence of MI in KTRs using myocardial perfusion imaging (MPI).
  • To assess the association between early post-transplant MI and long-term outcomes, including mortality, graft loss, and major adverse cardiovascular events (MACE).

Main Methods:

  • A retrospective observational study of asymptomatic KTRs undergoing post-transplant MPI screening.
  • MI defined by moderate to severe perfusion defects, post-stress stunning, or balanced ischemia.
  • Composite outcome of all-cause mortality, graft loss, and MACE analyzed over a minimum of 5 years.

Main Results:

  • 135 KTRs with 226 MPIs and 10 years follow-up were analyzed.
  • 10% of KTRs had MI; these patients showed significantly higher rates of composite outcomes (43%) and MACE (21%) compared to those without MI.
  • MI, high LDL, and proteinuria independently predicted composite outcomes; MI alone predicted MACE.

Conclusions:

  • Early detected MI post-kidney transplantation is a significant predictor of adverse long-term outcomes in KTRs.
  • MPI demonstrates excellent negative predictive value for MACE and composite outcomes.
  • While MI has poor positive predictive value, its presence warrants close monitoring and risk management in KTRs.
Keywords:
Follow-up studiesHeartKidney transplantationMyocardial ischemiaMyocardial perfusion imagingRisk assessment

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