Abstract
BackgroundDespite pre-kidney-transplant cardiovascular (CV) assessment being routine care to minimise perioperative risk, the utility of such assessment is not well established. The study reviewed the evaluation and outcome of a standardised CV assessment protocol.MethodsData were analysed for 231 patients (age 53.4 ± 12.9 years, diabetes 34.6%) referred for kidney transplantation between 1/2/2012-31/12/2014. One hundred forty-three patients were high-risk (age > 60 years, diabetes, CV disease, heart failure, peripheral vascular disease) and offered dobutamine stress echocardiography (DSE); 88 patients were low-risk and offered ECG and echocardiography with/without exercise treadmill test.ResultsAt the end of follow-up (579 ± 289 days), 35 patients underwent kidney transplantation and 50 were active on the waitlist. There were 24 events (CV or death), none were perioperative. One hundred fifteen patients had DSE with proportionally more events in DSE-positive compared to DSE-negative patients (6/34 vs. 7/81, p = 0.164). In 42 patients who underwent coronary angiography due to a positive DSE or ischaemic heart disease symptoms, 13 (31%) had events, 6 were suspended, 11 removed from waitlist, 3 wait-listed, 1 transplanted and 17 still undergoing assessment. Patients with significant coronary artery disease requiring intervention had poorer event-free survival compared to those without intervention (56% vs. 83% at 2 years, p = 0.044). However, the association became non-significant after correction for CV risk factors (HR = 3.17, 95% CI 0.51–19.59, p = 0.215).ConclusionsThe stratified CV risk assessment protocol using DSE in all high-risk patients was effective in identifying patients with coronary artery disease. The coronary angiograms identified the event-prone patients effectively but coronary interventions were not associated with improved survival.
Highlights
Despite pre-kidney-transplant cardiovascular (CV) assessment being routine care to minimise perioperative risk, the utility of such assessment is not well established
In the general population without renal failure, it is widely accepted that percutaneous coronary artery intervention in asymptomatic and stable coronary artery disease (CAD) does not reduce mortality and may only confer a modest improvement in quality of life that dissipates over time [6,7,8]
The gold standard treatment for patients with end stage renal disease (ESRD) is a kidney transplantation which offers better survival and quality of life compared to other forms of renal replacement therapy [9]
Summary
Despite pre-kidney-transplant cardiovascular (CV) assessment being routine care to minimise perioperative risk, the utility of such assessment is not well established. In the general population without renal failure, it is widely accepted that percutaneous coronary artery intervention in asymptomatic and stable coronary artery disease (CAD) does not reduce mortality and may only confer a modest improvement in quality of life that dissipates over time [6,7,8]. These studies have largely excluded patients with severe renal failure and these findings cannot be applied to these patients. Death has been reported as the leading cause of graft loss in patients aged above 40 years with cardiovascular disease and infection responsible for the majority [15]
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