J Korean Soc Transplant.  2011 Dec;25(4):225-228. 10.4285/jkstn.2011.25.4.225.

Cardiovascular Screening before Transplantation

• Kim YL

• KMID: 1450969
• DOI: http://doi.org/10.4285/jkstn.2011.25.4.225

Abstract

Because of the high prevalence of clinically silent cardiovascular disease and increased incidence of adverse cardiovascular events in transplant recipients, cardiovascular evaluation before transplantation is critical. The standard non-invasive screening tests for evaluating coronary artery disease include dobutamine stress echocardiogram and myocardial perfusion image (adenosine, dipyridamole nuclear scintigraphy). The optimal non-invasive screening test is unclear, with the optimal choice based upon the expertise of the particular medical center. The practitioner is advised to view current guidelines as recommendations rather than as strict rules and to combine them with clinical judgments. In addition, excessive reliance on noninvasive tests that are not sufficiently accurate to exclude significant coronary artery disease in high-risk candidates may engender a false sense of security.

Keyword

Transplantation; Mass screening; Cardiovascular diseases

MeSH Terms

Cardiovascular Diseases
Coronary Artery Disease
Dipyridamole
Dobutamine
Incidence
Judgment
Mass Screening
Perfusion
Prevalence
Transplants
Dipyridamole
Dobutamine

Figure

• 

  Fig. 1. Algorithm for cardiac assessment of high risk patients on the waiting list for kidney transplantation.

• 

  Fig. 2. Plain lumbar spine X-ray showing vascular calcification (white arrow).

Reference

References

1). Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004; 351:1296–305.

2). Ojo AO. Cardiovascular complications after renal transplantation and their prevention. Transplantation. 2006; 82:603–11.

3). Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Ishani A, et al. United States Renal Data System 2008 Annual Data Report. Am J Kidney Dis. 2009; 53(1 Suppl):S1–374.

4). Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999; 341:1725–30.

5). Tiukinhoy-Laing SD, Rossi JS, Bayram M, De Luca L, Gafoor S, Blei A, et al. Cardiac hemodynamic and coronary angiographic characteristics of patients being evaluated for liver transplantation. Am J Cardiol. 2006; 98:178–81.

6). Targher G, Arcaro G. Non-alcoholic fatty liver disease and increased risk of cardiovascular disease. Atherosclerosis. 2007; 191:235–40.

7). Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation. 2007; 116:1971–96.

8). Kasiske BL, Cangro CB, Hariharan S, Hricik DE, Kerman RH, Roth D, et al. The evaluation of renal transplantation candidates: clinical practice guidelines. Am J Transplant. 2001; 1(Suppl 2):3–95.

9). K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005; 45(4 Suppl 3):S1–153.

10). Gaston RS, Danovitch GM, Adams PL, Wynn JJ, Merion RM, Deierhoi MH, et al. The report of a national conference on the wait list for kidney transplantation. Am J Transplant. 2003; 3:775–85.

11). Herzog CA, Marwick TH, Pheley AM, White CW, Rao VK, Dick CD. Dobutamine stress echocardiography for the detection of significant coronary artery disease in renal transplant candidates. Am J Kidney Dis. 1999; 33:1080–90.

12). Delos Santos RB, Gmurczyk A, Obhrai JS, Watnick SG. Cardiac evaluation prior to kidney transplantation. Semin Dial. 2010; 23:324–9.

13). Rabbat CG, Treleaven DJ, Russell JD, Ludwin D, Cook DJ. Prognostic value of myocardial perfusion studies in patients with end-stage renal disease assessed for kidney or kidney-pancreas transplantation: a metaanalysis. J Am Soc Nephrol. 2003; 14:431–9.

14). Tsutsui JM, Mukherjee S, Elhendy A, Xie F, Lyden ER, O'Leary E, et al. Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease. Liver Transpl. 2006; 12:592–9.

15). EBPG (European Expert Group on Renal Transplantation); European Renal Association (ERA-EDTA); European Society for Organ Transplantation (ESOT). European Best Practice Guidelines for Renal Transplantation (part 1). Nephrol Dial Transplant. 2000; 15(Suppl 7):1–85.

16). De Lima JJ, Sabbaga E, Vieira ML, de Paula FJ, Ianhez LE, Krieger EM, et al. Coronary angiography is the best predictor of events in renal transplant candidates compared with noninvasive testing. Hypertension. 2003; 42:263–8.

17). Kim CD, Lee HJ, Kim DJ, Kim BS, Shin SK, Do JY, et al. High prevalence of leukoaraiosis in cerebral magnetic resonance images of patients on peritoneal dialysis. Am J Kidney Dis. 2007; 50:98–107.

18). Barbagallo CM, Pinto A, Gallo S, Parrinello G, Caputo F, Sparacino V, et al. Carotid atherosclerosis in renal transplant recipients: relationships with cardiovascular risk factors and plasma lipoproteins. Transplantation. 1999; 67:366–71.

19). Knoll G, Cockfield S, Blydt-Hansen T, Baran D, Kiberd B, Landsberg D, et al. Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation. CMAJ. 2005; 173:1181–4.