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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Cardiovascular Outcomes Among ESRD Patients Undergoing Kidney Transplantation
Yaacov Goykhman1, Ayelet Grupper1, Maisaa Shararym2
1Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Organ Transplantation Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel.
Insights
Pre-transplant cardiovascular evaluation did not improve survival or reduce events in kidney transplant recipients. Tailored therapy and post-transplant monitoring are suggested for managing cardiovascular risk in this high-risk group.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular disease (CVD) is a major cause of mortality in kidney transplant recipients (KTR).
- Pre-transplant screening for coronary artery disease (CAD) effectiveness in KTR is uncertain.
- High cardiovascular risk exists in patients with chronic kidney disease (CKD) undergoing kidney transplantation (KT).
Purpose of the Study:
- Evaluate cardiovascular risk factors in patients undergoing KT.
- Assess the predictive value of pre-transplant cardiovascular evaluations.
- Determine the incidence of cardiovascular mortality post-transplantation.
Main Methods:
- Retrospective analysis of 350 adult kidney transplant recipients (2015-2021).
- Inclusion of cardiovascular risk factors, pre-transplant evaluations (stress tests, coronary imaging), and post-transplant outcomes.
- Univariable and multivariable statistical analyses to identify predictors of post-transplant cardiac interventions and mortality.
Main Results:
- One-third of patients had pre-existing cardiovascular disease; 63% had pre-transplant myocardial perfusion imaging (MPI).
- Pre-transplant cardiovascular disease independently predicted increased post-transplant mortality.
- Heart failure and ischemic heart disease significantly predicted post-transplant coronary interventions and cardiovascular death.
Conclusions:
- Routine pre-transplant cardiac evaluation did not reduce post-transplant catheterization or improve survival.
- Ongoing cardiovascular risk is evident in KTR, with a high burden of pre-existing disease.
- Tailored medical therapy and post-transplant monitoring may be more effective than invasive pre-transplant interventions.
Background:
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.
Objective:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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