Renal and Cardiovascular Outcomes in Renal Transplant Candidates According to Coronary Status

To date, there is no consensus regarding coronary artery disease (CAD) screening strategy among renal transplant candidates. This study sought to evaluate the association between the coronary status at waitlisting for renal transplant with both cardiovascular and renal outcomes in renal transplant candidates.

Patients waitlisted for renal transplant were stratified in 4 groups: 1/prior CAD 2/negative screening for CAD 3/positive screening for CAD 4/ no screening. Primary outcome was a composite of death, myocardial infarction, or unplanned revascularization, analyzed with multivariate Cox model including screening group as a time-dependent covariate. Secondary outcome was renal transplantation rates. Negative screening for CAD was considered as reference.

From 2005 to 2023, 3248 patients were waitlisted for renal transplantation, among whom 228 (7.0%) had prior CAD, 1987 (61.2%) patients were screened for CAD resulting in 133/1987 (6.7%) of patients with obstructive CAD, and 1033 (31.8%) were not screened. Within a median follow-up of 5.1 years, prior CAD was associated with a higher risk or primary outcome (adjusted hazard ratio [aHR], 1.67 [95% CI, 1.22-2.24]) and with less frequent access to renal transplantation (11.8% at 3 years versus 28.7% for patients with absence of screening). Positive CAD screening was not associated with a higher risk or primary outcome (aHR, 1.20 [95% CI, 0.77-1.77]) but with lower rates of renal transplant (15.0% at 3 years).

Patients with known CAD at waitlisting carry the highest cardiovascular burden and have poor access to transplantation. Newly diagnosed CAD based on routine screening at waitlisting was rare and did not have an impact on cardiovascular outcomes but reduced access to renal transplantation.