Cardiovascular Outcomes Among ESRD Patients Undergoing Kidney Transplantation

Cardiovascular disease (CVD) is a leading cause of mortality in patients with chronic kidney disease (CKD) following kidney transplantation (KT). Despite recommendations for pre-transplant cardiovascular evaluation, the effectiveness of screening for coronary artery disease (CAD) in improving survival or reducing cardiovascular events remains uncertain.

This retrospective study aims to evaluate the prevalence of cardiovascular risk factors in patients undergoing KT, assess the predictive value of pre-transplant cardiovascular evaluations, and determine the incidence of cardiovascular mortality post-transplantation.

We retrospectively analyzed data from 350 adult kidney transplant recipients at a single medical center who underwent KT between 2015 and 2021. The study included cardiovascular risk factors, pre-transplant evaluations (including stress tests and coronary imaging), and post-transplant outcomes. Univariable and multivariable statistical analyses were conducted to identify predictors of post-transplant cardiac interventions and mortality.

One-third of patients had documented cardiovascular disease prior to KT, and 63% underwent pre-transplant myocardial perfusion imaging (MPI). Of the 47 patients who underwent cardiac catheterization before KT, only 14.9% received coronary revascularization. During the follow‑up period, 51 patients (14.5%) died, of whom 26 (51%) deaths were attributed to cardiovascular causes. Pre-transplant cardiovascular disease was an independent risk factor for increased post-transplant mortality, with heart failure and ischemic heart disease before transplantation being significant predictors of post-transplant coronary interventions and cardiovascular death.

Our study demonstrates ongoing cardiovascular risk in kidney transplant recipients, with a high burden of pre-existing disease. Routine pre-transplant cardiac evaluation did not reduce post-transplant catheterization or improve survival, suggesting that tailored medical therapy and post-transplant monitoring may be more effective than invasive pre-transplant interventions in this high-risk population.