Yaacov Goykhman, Ayelet Grupper, Maisaa Shararym, Ilan Rabey, Gad Keren, Yacov Shacham, May-Tal Rofe Shmuel
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.
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.