Class 1 Indications for Coronary Revascularization Identified in Prekidney Transplant Screening

Area of Science:

• Cardiology
• Nephrology
• Transplant Surgery

Background:

• Cardiovascular disease (CVD) is a leading cause of death in kidney transplant recipients.
• Pre-transplant screening for coronary artery disease (CAD) is common, but its benefit is debated.
• Intervention for CAD is only proven beneficial in complex cases.

Purpose of the Study:

• To systematically review and meta-analyze the frequency of significant coronary artery disease (CAD) detected during pre-kidney transplant screening.
• To determine the prevalence of CAD requiring revascularization based on AHA class 1 indications.

Main Methods:

• Systematic review and meta-analysis of studies published between 1998 and 2024.
• Searched Medline and Embase databases for pre-transplant screening data.
• Primary endpoints: >50% left main stenosis or multi-vessel disease with ejection fraction <35%.

Main Results:

• 44 studies including 1273 identified papers were analyzed.
• Prevalence of AHA class 1 indications for revascularization was low (mean 2%, range 0-17%).
• Prevalence of proximal LAD disease was 2%, left main stenosis 1%, and multi-vessel disease 10%; 35% underwent angiography.

Conclusions:

• Identification of class I indications for revascularization during pre-transplant coronary screening is rare.
• The utility of routine screening for significant CAD in kidney transplant candidates requires further evaluation.