Computed Tomography Coronary Angiogram to Exclude Significant Coronary Artery Disease in Prospective Renal Transplant Candidates

Abstract

Background: Patients with end stage renal failure (ESRF) require exclusion of significant coronary artery disease (CAD) before being listed for renal transplant. Functional assessment such as stress echocardiography is usually performed initially but these often have equivocal results in this population. CT coronary angiography (CTCA) may be an appropriate second line test to exclude CAD rather than an invasive coronary angiogram (ICA). Methods: Patients undergoing CTCA (Siemens Definition Flash) following abnormal or equivocal stress echocardiography were evaluated for image quality, diagnostic findings and whether they required ICA before being listed for transplant assessment. The studies were co-reported by a radiologist and cardiologist. Results: Twenty-three ESRF patients aged 49 ± 9.0 years with average BMI 31 ± 6 kg/m2, 56 % Pacific Islander, 30 % Māori. All were on renal replacement therapy, 58 % due to diabetic nephropathy. Image quality was good (38 %) or adequate (54 %) and 4 % of scans were of poor quality. CTCA demonstrated that fourteen (58 %) had non-significant CAD while eight (33 %) had significant CAD; one was non-diagnostic. No non-diabetic patients had significant CAD (p < 0.05). Of the eight patients with significant CAD, four proceeded to ICA (one false positive). Three of the fourteen patients with non-significant CAD proceeded to renal transplant. Conclusion: CTCA excluded significant CAD in approximately half of ESRF patients who had an equivocal stress echocardiogram, allowing them to be listed for renal transplant. CTCA may be particularly useful in the non-diabetic ESRF population.