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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study
Swati Vijayan1, Quan Yao Ho2,3, Choong Hou Koh4
1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Insights
Cardiac evaluation before deceased donor kidney transplant (DDKT) is debated. This study found significant coronary artery disease in 42.8% of patients, highlighting the importance of pretransplant cardiac screening for identifying high-risk individuals.
Area of Science:
- Nephrology
- Cardiology
- Transplant Surgery
Background:
- Cardiac evaluation before deceased donor kidney transplant (DDKT) is debated, with limited data from Asia and long wait times.
- This study addresses the need for data on cardiac assessment outcomes in DDKT candidates in these settings.
Purpose of the Study:
- To assess the outcomes of patients referred for DDKT after cardiac evaluation at an Asian tertiary transplant center.
- To determine the prevalence of significant coronary artery disease (CAD) and major adverse cardiovascular events (MACE) in this population.
Main Methods:
- Retrospective review of 198 patients undergoing cardiac stress testing for DDKT waitlist placement (2009-2015).
- Exclusion of patients with cardiac symptoms.
- Primary outcome: three-point MACE (myocardial infarction, stroke, cardiovascular death).
Main Results:
- 20.7% of patients experienced MACE over 4.6 years.
- Cardiac stress tests were positive for ischemia in 19.7%.
- Significant CAD was detected in 42.8% of patients undergoing coronary angiography, with 37.9% of diabetic patients with negative stress tests having significant CAD.
Conclusions:
- A significant cardiovascular disease burden exists in DDKT waitlist candidates.
- Pretransplant cardiac screening is crucial for identifying patients with significant CAD and high MACE risk.
- Coronary angiography findings, not stress tests, were associated with MACE.
Background:
Cardiac evaluation before deceased donor kidney transplant (DDKT) remains a matter of debate. Data on Asian countries and countries with prolonged waiting times are lacking. This study aimed to assess the outcomes of patients referred for DDKT after a cardiac evaluation at an Asian tertiary transplant center.
Methods:
This single-center retrospective review analyzed patients who were referred for waitlist placement and underwent cardiac stress testing between January 2009 and December 2015. Patients with cardiac symptoms were excluded. The primary outcome was three-point major adverse cardiovascular events (MACE), a composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death.
Results:
Of 468 patients referred for DDKT, 198 who underwent cardiac stress testing (myocardial perfusion studies in 159 patients and stress echocardiography in 39 patients) were analyzed. MACE occurred in 20.7% of the patients over a median follow-up of 4.6 years. Cardiac stress tests were positive for ischemia in 19.7% of the patients. Coronary angiography was performed in 63 patients, including 29 patients with diabetic kidney disease and negative cardiac stress tests. Significant coronary artery disease (CAD) was detected in 27 patients (42.8%), of whom 18 underwent revascularization. MACE was associated with significant CAD on coronary angiography in the multivariable analysis. Cardiac stress test results were not associated with MACE. Amongst diabetic patients who had negative cardiac stress tests, 37.9% had significant CAD on coronary angiography.
Conclusions:
The cardiovascular disease burden is significant amongst DDKT waitlist candidates. Pretransplant cardiac screening may identify patients with significant CAD at higher risk of MACE.
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