Role of Cardiac Evaluation and Management in Kidney and Liver Transplant Candidates.
Complex Medical Conditions, Optum, UnitedHealth Group, Eden Prairie, MN
Surgery, St Louis University, St Louis, MO.
Meeting: 2016 American Transplant Congress
Abstract number: 177
Keywords: Kidney transplantation, Liver transplantation, Survival, Waiting lists
Session Information
Session Name: Concurrent Session: Novel Predictors of Outcome, Big Data and Technology
Session Type: Concurrent Session
Date: Monday, June 13, 2016
Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Location: Room 302
Cardiac evaluation and risk stratification prior to kidney and liver transplantation can be critical to patient selection and outcomes.
Methods: We assessed the impact of cardiac evaluation on waitlist entry, transplant rate, and survival among transplant candidates. Patients who were referred for kidney or liver transplant evaluation were drawn from a database of a large commercial health plan. Using multivariate proportional hazard models, we estimated time-to-event mortality and wait-list entry outcomes for patients referred between January 2010 and March 2015. Outcomes were followed up through April 30, 2015. Outcome analysis was adjusted for age, gender, patient comorbid conditions, transplant primary diagnosis, UNOS region, and socio-economic status.
Results: A total of 7,097 patients evaluated for a kidney transplant and 3,071 evaluated for a liver transplant were included in the study. Stress testing was common in both populations showing lower rates of catheterization, angiography and revascularization.
| Organ | Stress Test | Catheterization | Angiography | Revascularization (PCI or CABG) |
| Kidney | 56.9% | 5.9% | 0.6% | 5.5% |
| Liver | 50.9% | 4.2% | 1.5% |
1.3% |
Stress testing was associated with a lower probability of mortality among patients who were evaluated. No other significant mortality effects were observed.
Stress testing was also associated with a higher probability of waitlist entry among liver transplant candidates. Catheterization was associated with increased probability of waitlist entry in both kidney and liver transplant candidates. Having the patient undergo a revascularization was associated with lower likelihood of waitlist entry among kidney candidates.
| Outcome | Organ | Stress Test | Catheterization | Angiography | Revascularization (PCI or CABG) |
| Mortality | Kidney | 0.64*** | 1.32 | 1.19 | 0.89 |
| Mortality | Liver | 0.71**** | 1.19 | 1.43 | 0.56 |
| Waitlist Entry | Kidney | 1.06 | 1.30*** | 1.02 | 0.82* |
| Waitlist Entry | Liver | 1.24*** | 1.40** | 0.68 | 0.74 |
****P < 0.0001, ***P < 0.001, **P < 0.01, *P < 0.05.
Conclusions: Cardiac screening and intervention have significant impacts on patient survival and access to the waiting list in kidney and liver transplant candidates. In the future we hope to also be able to report on the effect of cardiac screening of transplant candidates on total medical cost before, during and post transplantation.
CITATION INFORMATION: Bannister W, Wu C, Schnitzler M, Bonagura A, Laihinen B, Irwin F. Role of Cardiac Evaluation and Management in Kidney and Liver Transplant Candidates. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Bannister W, Wu C, Schnitzler M, Bonagura A, Laihinen B, Irwin F. Role of Cardiac Evaluation and Management in Kidney and Liver Transplant Candidates. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/role-of-cardiac-evaluation-and-management-in-kidney-and-liver-transplant-candidates/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress