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Updated: Jul 2, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
The Minimisation of Cardiovascular Disease Screening for Kidney Transplant Candidates
Michael Corr1, Amber Orr2, Aisling E Courtney3
1Centre for Public Health, Institute of Clinical Sciences B, Royal Victoria Hospital, Queen's University Belfast, Belfast BT12 6BA, UK.
Insights
Minimal cardiac screening before kidney transplantation showed comparable cardiovascular event rates in asymptomatic patients. This real-world data suggests extensive pre-transplant cardiac testing may not improve outcomes.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Growing evidence suggests pre-kidney transplant cardiac screening offers no outcome benefits.
- Risk aversion leads to common testing, limiting real-world data for practice change.
- Minimal screening data is needed to evaluate perioperative and post-transplant cardiovascular events.
Purpose of the Study:
- To assess perioperative and 1-year post-transplant cardiovascular events.
- To evaluate outcomes in kidney transplant candidates receiving minimal cardiovascular screening.
Main Methods:
- Retrospective cohort study of adult kidney-only transplant recipients (Jan 2015 - Dec 2021).
- Asymptomatic recipients, even with risk factors, did not undergo cardiac stress testing.
- Logistic regression identified predictors of cardiovascular or cerebrovascular events.
Main Results:
- 895 recipients included; 23% had prior cardiac diagnosis, 22% had diabetes.
- Perioperative events occurred in 2% (18 patients); 5.7% had 1-year post-transplant cardiovascular events.
- Cardiovascular mortality was 0% perioperatively, 0.2% at 3 months, and 0.2% at 1 year.
Conclusions:
- Reduced screening in asymptomatic kidney transplant recipients showed comparable cardiovascular event rates.
- Study included higher-risk individuals, suggesting extensive screening may not be beneficial.
- Findings support that extensive pre-transplant cardiac screening is unlikely to be offset by reduced cardiovascular events.
Abstract:
Background: There is increasing evidence that cardiac screening prior to kidney transplantation does not improve its outcomes. However, risk aversion to perioperative events means that, in practice, testing remains common, limiting the availability of 'real-world' data to support any change. Our objective was to assess perioperative and 1-year post-transplant cardiovascular events in a kidney transplant candidate cohort who received minimal cardiovascular screening. Methods: The retrospective cohort study included all adult kidney-only transplant recipients in a single UK region between January 2015 and December 2021. Kidney transplant recipients asymptomatic of cardiac disease, even those with established risk factors, did not receive cardiac stress testing. The perioperative and 1-year post-transplant cardiovascular event incidences were examined. Logistic regression was used to identify variables of statistical significance that predicted cardiovascular or cerebrovascular events. Results: A total of 895 recipients fulfilled the inclusion criteria. Prior to transplantation, 209 (23%) recipients had an established cardiac diagnosis, and 193 (22%) individuals had a diagnosis of diabetes. A total of 18 (2%) patients had a perioperative event, and there was a 5.7% incidence of cardiovascular events 1 year post-transplantation. The cardiovascular mortality rate was 0.0% perioperatively, 0.2% at 3 months post-transplant, and 0.2% at 1 year post-transplant. Conclusions: This study demonstrates comparable rates of cardiovascular events despite reduced screening in asymptomatic recipients. It included higher risk individuals who may, on the basis of screening results, have been excluded from transplantation in other programmes. It provides further evidence that extensive cardiac screening prior to kidney transplantation is unlikely to be offset by reduced rates of cardiovascular events.
