Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Cardiovascular disease is the leading cause of mortality after kidney transplantation and optimal approaches to pre-transplant cardiac testing are not well defined. We applied a standardized approach to cardiac testing during the pre-transplant evaluation phase. Candidates were classified as low, intermediate, high, or very high risk. The objective of this study is to determine the effects of this standardized approach on cardiac events post-transplant.
*Methods: This is a single center, retrospective study of kidney transplant recipients three years before and three years after implementing our standardized cardiac testing protocol. The primary endpoint was either an MI, need for emergent revascularization, hospitalizations for unstable angina, or cardiac death (CV event). Event-free survival was calculated using the Kaplan-Meier survivor function while hazard ratios were calculated using Cox proportional hazards models that were adjusted for demographic factors and co-morbidities.
*Results: The cohort consists of 419 transplant recipients that received a transplant between 2013-2018 with 184 prior to the change in protocol (Pre) versus 235 transplanted after the change in protocol (Post). The Pre group was older (52.8 years vs 50 years old, p=0.047) and with less diabetic kidney disease (21% vs 34%, p=0.008). More angiograms were performed as part of the evaluation in the Post group, especially among the high risk (87% Post vs 9% Pre) and very high risk groups (67% Post vs 50% Pre) and resulted in more percutaneous coronary interventions (20% Post vs 8% Pre) and coronary artery bypass grafts (13% Post vs 8% Pre) prior to transplant. The risk of CV event was lower in the Post group (adjusted HR 0.59, 0.35-0.98). The table shows significant risk reductions in the intermediate and high risk Post groups.
|Low Risk||1.0 (ref)||0.63 (0.14-2.8)|
|Intermediate . Risk||4.3 (1.4-13.2)||1.4 (0.36-5.7)|
|High Risk||6.3 (2.0-19.7)||3.1 (0.98-9.7)|
|Very High Risk||9.6 (3.2-28.7)||8.4 (2.6-27.2)|
*Conclusions: Implementation of a standardized cardiac evaluation protocol resulted in a 41% reduction in risk for a CV event post-transplant. More studies are needed to determine if increased coronary angiography in high cardiac risk candidates during the pre-transplant evaluation phase can improve long-term patient survival.
To cite this abstract in AMA style:Genev I, Desai A, Garcia-Roca R, Shah S, Lopez J, Mathew V, Yoo J, Akkina S. Standardization of Pre-Transplant Cardiac Testing in Kidney Transplant Recipients is Associated with Lower Post-Transplant Cardiac Events [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/standardization-of-pre-transplant-cardiac-testing-in-kidney-transplant-recipients-is-associated-with-lower-post-transplant-cardiac-events/. Accessed October 26, 2020.
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