Cardiac evaluation of the kidney or liver transplant candidate

Abstract

Purpose of review As the field of transplant has advanced, cardiac events have become the leading cause of morbidity and mortality after liver and kidney transplantation ahead of graft failure and infection. This trend has been bolstered by the transplantation of older and sicker patients who have a higher burden of cardiovascular risk factors, accentuating the need to determine which patients should undergo more extensive cardiac evaluation prior to transplantation. Recent findings Computed tomography coronary angiography with or without coronary artery calcium scoring is now preferred over stress imaging in most transplant candidates for assessment of coronary artery disease. Assessment of cardiac structure and function using transthoracic echocardiography with tissue doppler imaging and strain imaging is recommended, particularly in liver transplant candidates who are at high risk of cirrhotic cardiomyopathy, for which new diagnostic criteria were recently published in 2019. Summary Cardiac evaluation of liver and kidney transplant candidates requires a global assessment for both short and long-term risk for cardiac events. Imaging of cardiac structure and function using transthoracic echocardiography with tissue doppler imaging and strain imaging is recommended. Risk stratification should consider both the anatomic and functional consequences of coronary artery disease in transplant candidates. Video abstract http://links.lww.com/MOT/A27

NAFLD: A pretransplant and post-transplant conundrum

“…In patients listed for NAFLD, ASCVD-related mortality is high and is most commonly related to dysrhythmias (atrial fibrillation), followed by heart failure, strokes, and ischemic heart disease. [16] Pretransplant coronary artery disease (CAD) may also persist after LT and lead to negative ASCVD outcomes after LT. [17] Early identification of CAD in LT candidates is important as revascularization improves 1-year post-transplant mortality, especially in asymptomatic patients, where rates of post-transplant myocardial infarction are markedly high (24%). [16]…”

“…[16] Pretransplant coronary artery disease (CAD) may also persist after LT and lead to negative ASCVD outcomes after LT. [17] Early identification of CAD in LT candidates is important as revascularization improves 1-year post-transplant mortality, especially in asymptomatic patients, where rates of post-transplant myocardial infarction are markedly high (24%). [16]…”

“…In patients listed for NAFLD, ASCVD-related mortality is high and is most commonly related to dysrhythmias (atrial fibrillation), followed by heart failure, strokes, and ischemic heart disease 16. Pretransplant coronary artery disease (CAD) may also persist after LT and lead to negative ASCVD outcomes after LT 17.…”

Preoperative Cardiovascular Assessment of the Renal Transplant Recipient: A Narrative Review

“…The presence of pre-transplantation cardiac arrhythmias is associated with an increased risk of morbidity, mortality and graft loss post-transplantation with up to 46% higher risk of mortality at five-year follow-up in patients with atrial fibrillation [ 81 ]. Although arrhythmias are associated with poor outcomes, there is limited testing available to predict the risk of sudden cardiac death and only a baseline ECG is currently recommended at the time of pre-transplant evaluation and there is insufficient evidence to support evaluation through ambulatory rhythm monitoring [ 82 ]. In a single-centre study of post-kidney transplantation ventricular arrhythmias: male gender, dialysis vintage and high preexisting CACS were associated with post-transplantation ventricular arrhythmias [ 83 ].…”

Kidney Transplantation and Diagnostic Imaging: The Early Days and Future Advancements of Transplant Surgery

“…Diagnostic imaging procedures for non-invasive assessment of cardiac function include CT coronary angiography and myocardial perfusion imaging (MPI). Future studies are required to establish the role of these procedures for cardiovascular risk stratification [54].…”