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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Impact of cardiovascular risk stratification strategies in kidney transplantation over time
Andras T Deak1, Francesca Ionita1, Alexander H Kirsch1
1Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria.
Insights
A new screening program for kidney transplant candidates increased cardiac imaging but did not improve cardiovascular outcomes. This study evaluated cardiovascular risk stratification and post-transplant events in kidney transplant recipients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Kidney transplant recipients face significantly elevated cardiovascular (CV) risks.
- A 2007 Austrian consensus mandated comprehensive pre-kidney transplantation (KT) CV screening, focusing on coronary artery disease (CAD) detection.
- Screening utilized cardiac computed tomography (CT) or coronary angiography (CAG) for high-risk patients.
Purpose of the Study:
- To assess the impact of a comprehensive CV screening program on risk stratification.
- To evaluate post-transplant CV outcomes in kidney transplant recipients following the screening program's implementation.
- To determine if intensified pre-transplant CV screening affects major adverse cardiac events (MACE).
Main Methods:
- Retrospective chart review of 551 kidney transplants (KTs) from 2003-2015.
- Patients grouped by KT timing: pre-consensus (2003-07), early post-consensus (2008-11), and later post-consensus (2012-15).
- Analysis of clinical characteristics, pre-KT cardiac CT/CAG rates, and 2-year post-KT MACE.
Main Results:
- Homogeneous patient demographics and comorbidities across all groups.
- Significantly increased rates of cardiac CT (13.6% vs. 10.2% vs. 44.8%) and CAG (39.6% vs. 43.9% vs. 56.2%) post-consensus implementation.
- No significant difference in 2-year MACE incidence (8.7% cumulative) between the groups, despite increased screening.
Conclusions:
- Pre-transplant CV risk stratification became more rigorous and invasive after the consensus.
- The intensified screening protocol did not lead to improved post-transplant CV outcomes.
- Further research may be needed to optimize CV risk management in kidney transplant candidates.
Background:
Kidney transplant recipients exhibit a dramatically increased cardiovascular (CV) risk. In 2007, Austrian centres implemented a consensus of comprehensive CV screening programme prior to kidney transplantation (KT). The consensus placed a particular emphasis on screening for coronary artery disease (CAD) with cardiac computed tomography (CT) or coronary angiography (CAG) in patients with diabetes mellitus, known CAD or those having multiple conventional CV risk factors. Here, we investigate if this affected risk stratification and post-transplant CV outcomes.
Methods:
In a retrospective chart review, we evaluated 551 KTs performed from 2003 to 2015 in our centre. Patients were categorized into three groups: KT before (2003-07), directly after (2008-11) and 5 years after (2012-15) implementation of the consensus. We analysed clinical characteristics, the rate of cardiac CTs and CAGs prior to KT as well as major adverse cardiac events (MACEs) during a 2-year follow-up after KT.
Results:
The three study groups showed a homogeneous distribution of comorbidities and age. Significantly more cardiac CTs (13.6% versus 10.2% versus 44.8%; P = 0.002) and CAGs (39.6% versus 43.9% versus 56.2%; P = 0.003) were performed after the consensus. Coronary interventions were performed during 42 out of 260 CAGs (16.2%), the cumulative 2-year MACE incidence was 8.7%. Regarding MACE occurrence, no significant difference between the three groups was found.
Conclusion:
CV risk stratification has become more rigorous and invasive after the implementation of the consensus; however, this was not associated with an improvement in CV outcome.
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