*Purpose: Appropriate cardiac evaluation prior to kidney transplantation is controversial. The following retrospective analysis was performed to evaluate the value of performing cardiac catheterization on renal transplant candidates according to defined criteria.

*Methods: Over a five month period between March 2018 and August 2018, renal transplant patients were referred for cardiac catheterization over stress testing using the following criteria: history of peripheral vascular disease, >10 years of diabetes mellitus, > five years of hemodialysis treatment and an estimated pulmonary systolic pressure > 60 mmHg on echocardiogram. Data was collected regarding positive findings including percutaneous cardiac interventions, referral for cardiac surgery, referral to pulmonology, referral to heart failure service and referral to cardiac electrophysiology for diagnosis and treatment of arrhythmia issues found on catheterization.

*Results: Of the 32 patients referred for catheterization over stress testing, 41% had positive findings requiring referral or treatment. The patients with positive results required the following treatments: 46% were referred for cardiac surgery; 15% required percutaneous cardiac interventions; 15% had confirmed significant pulmonary hypertension and were referred to pulmonology for treatment; 15% were referred to the heart failure service and 9% were referred for cardiac electrophysiology testing and treatment.

*Conclusions: Conclusions: Cardiac evaluation of transplant kidney transplant candidates is controversial. Recommendations by cardiology professional associations are based on preoperative evaluations of patients undergoing non-cardiac surgical procedures and do not take into account the issues surrounding outcomes of transplants in patients that require cardiac interventions due to myocardial events in the immediate post transplant period. With an expected graft survival of 92-93% following deceased donor renal transplant and 97-98% following living donor renal transplant, we believe that an aggressive protocol to perform cardiac catheterization is warranted.

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