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Background and Aims Cardiovascular screening of kidney transplant candidates is currently recommended, although the patient value is presently questioned. The prognostic ability is known, whereas systematic screening may have less recognized effects such as incidental findings, triggering of additional investigations, procedural complications, delay of transplantation and deselection of patients for kidney transplantation. To address this, we characterized the diagnostic yield and clinical implications of systematic screening for cardiovascular disease using cardiac computed tomography (CT) in asymptomatic kidney transplant candidates. Method In a single-centre, observational study, we included all potential kidney transplant candidates ≥ 40 years or with diabetes or on dialysis treatment ≥ 5 years, who were systematically referred to cardiac CT (a non-contrast enhanced CT scan and a coronary CT angiography) prior to kidney transplantation between March 2014 and September 2019 in North and Central Denmark Regions. Patient records were examined to obtain data on baseline characteristics, additional investigations, incidental findings, conference decisions. Results In total, 473 patients underwent cardiac CT. The screening programme led to additional cardiac investigations in 155 patients (33%) and 7% were revascularised. Thirty patients (6%) had significant incidental non-vascular findings on cardiac CT, but only 4 patients were changed in medical management based on these findings. Furthermore, no patients were rejected for transplantation based on the cardiac CT. In patients not yet on dialysis, the slope in eGFR decline did not change significantly after coronary CT angiography. Conclusion The clinical significance of the screening by cardiac CT was limited, and one third of patients had to go through additional investigations. Few patients were revascularised and no patients rejected for transplantation. No evidence of contrast-induced acceleration of kidney function decline was observed.

A 45-year-old woman was admitted with severe pain in the right leg and dyspnea. Her medical history included previous Staphylococcus aureus endocarditis, biological aortic valve replacement, and intravenous drug abuse. She was febrile but did not have any focal signs of infection. Blood tests showed raised infectious markers and troponin levels. Electrocardiogram showed sinus rhythm without signs of ischemia. Ultrasound revealed thrombosis of the right popliteal artery. The leg was not critically ischemic, and therefore, treatment with dalteparin was chosen. Transesophageal echocardiography showed an excrescence on the biological aortic valve. Empiric treatment for endocarditis was started with intravenous vancomycin, gentamicin, and oral rifampicin. Blood cultures subsequently grew Staphylococcus pasteuri. On day 2, treatment was changed to intravenous cloxacillin. Due to the comorbidity, the patient was not a candidate for the surgical treatment. On day 10, the patient developed moderate expressive aphasia and weakness in the right upper limb. Magnetic resonance imaging showed micro-embolic lesions scattered across both hemispheres of the brain. Treatment was changed from cloxacillin to cefuroxime. On day 42, infectious markers were normal, and echocardiography showed regression of the excrescence. Antibiotic treatment was stopped. Follow-up on day 52 did not show any signs of active infection. However, on day 143, the patient was readmitted with cardiogenic shock due to aortic root fistulation to the left atrium. She quickly deteriorated and died.