Pre-Operative Cardiovascular Testing and Post-Renal Transplant Clinical Outcomes.
Pre-Operative Cardiovascular Testing and Post-Renal Transplant Clinical Outcomes.
- 2019
BACKGROUND: Cardiovascular disease, a major contributor to morbidity and mortality in chronic kidney disease and kidney transplant patients, is closely evaluated before kidney transplant. We aimed to characterize pre-transplant cardiac testing practices and post-transplant cardiac outcomes at a single academic center. CONCLUSIONS: Non-invasive functional testing is common prior to renal transplantation, with most being normal. Few patients are revascularized before transplantation. Perioperative death and acute coronary syndrome are rare, but troponin elevations due to type II NSTEMI and myocardial injury are common. Copyright (c) 2019 Elsevier Inc. All rights reserved. METHODS: This was a retrospective, single-center analysis of consecutive adults receiving first renal transplant from 1/1/2016 to 6/31/2017. Data included demographics, medical history, and medications. Pre-transplant workup included echocardiograms, cardiac stress testing, coronary computed tomography, left heart catheterization (LHC), and any revascularization. Outcomes included all-cause mortality, cardiac mortality, myocardial infarction (MI), and myocardial injury. RESULTS: Our analysis included 235 patients with mean follow-up of 1.6+/-0.53years. Of these, 219 (93%) patients had non-invasive functional testing before transplant, with 198 normal and 21 abnormal. The most common modalities were dobutamine stress echocardiogram (88) and pharmacological myocardial perfusion imaging (60). Twenty-four (10%) patients had an LHC, including 14 abnormal studies, and 10 who subsequently underwent successful revascularization. There were 3 deaths, 2 that were cardiac-specific. There were no ST-elevation MIs and 1 Type I non-ST-elevation MI (NSTEMI), occurring 2days after transplant. Of those patients with a 30-day post-operative troponin, 30 (13%) patients had an elevation due to a type II NSTEMI or myocardial injury.
English
1878-0938
*Cardiac Catheterization
*Cardiac Imaging Techniques
*Cardiovascular Diseases/di [Diagnosis]
*Kidney Transplantation
*Preoperative Care
*Renal Insufficiency, Chronic/su [Surgery]
Adult
Aged
Cardiovascular Diseases/co [Complications]
Cardiovascular Diseases/mo [Mortality]
Cardiovascular Diseases/th [Therapy]
Cause of Death
Female
Humans
Kidney Transplantation/ae [Adverse Effects]
Kidney Transplantation/mo [Mortality]
Male
Middle Aged
Myocardial Revascularization
Predictive Value of Tests
Renal Insufficiency, Chronic/co [Complications]
Renal Insufficiency, Chronic/di [Diagnosis]
Renal Insufficiency, Chronic/mo [Mortality]
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult
MedStar Heart & Vascular Institute
Journal Article
BACKGROUND: Cardiovascular disease, a major contributor to morbidity and mortality in chronic kidney disease and kidney transplant patients, is closely evaluated before kidney transplant. We aimed to characterize pre-transplant cardiac testing practices and post-transplant cardiac outcomes at a single academic center. CONCLUSIONS: Non-invasive functional testing is common prior to renal transplantation, with most being normal. Few patients are revascularized before transplantation. Perioperative death and acute coronary syndrome are rare, but troponin elevations due to type II NSTEMI and myocardial injury are common. Copyright (c) 2019 Elsevier Inc. All rights reserved. METHODS: This was a retrospective, single-center analysis of consecutive adults receiving first renal transplant from 1/1/2016 to 6/31/2017. Data included demographics, medical history, and medications. Pre-transplant workup included echocardiograms, cardiac stress testing, coronary computed tomography, left heart catheterization (LHC), and any revascularization. Outcomes included all-cause mortality, cardiac mortality, myocardial infarction (MI), and myocardial injury. RESULTS: Our analysis included 235 patients with mean follow-up of 1.6+/-0.53years. Of these, 219 (93%) patients had non-invasive functional testing before transplant, with 198 normal and 21 abnormal. The most common modalities were dobutamine stress echocardiogram (88) and pharmacological myocardial perfusion imaging (60). Twenty-four (10%) patients had an LHC, including 14 abnormal studies, and 10 who subsequently underwent successful revascularization. There were 3 deaths, 2 that were cardiac-specific. There were no ST-elevation MIs and 1 Type I non-ST-elevation MI (NSTEMI), occurring 2days after transplant. Of those patients with a 30-day post-operative troponin, 30 (13%) patients had an elevation due to a type II NSTEMI or myocardial injury.
English
1878-0938
*Cardiac Catheterization
*Cardiac Imaging Techniques
*Cardiovascular Diseases/di [Diagnosis]
*Kidney Transplantation
*Preoperative Care
*Renal Insufficiency, Chronic/su [Surgery]
Adult
Aged
Cardiovascular Diseases/co [Complications]
Cardiovascular Diseases/mo [Mortality]
Cardiovascular Diseases/th [Therapy]
Cause of Death
Female
Humans
Kidney Transplantation/ae [Adverse Effects]
Kidney Transplantation/mo [Mortality]
Male
Middle Aged
Myocardial Revascularization
Predictive Value of Tests
Renal Insufficiency, Chronic/co [Complications]
Renal Insufficiency, Chronic/di [Diagnosis]
Renal Insufficiency, Chronic/mo [Mortality]
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult
MedStar Heart & Vascular Institute
Journal Article