Coronary artery disease in renal transplant recipients: an angiographic study

Paizis, Ioannis; Mantzouratou, Polyxeni; Tzanis, Georgios; Melexopoulou, Christina; Darema, Maria; Boletis, John; Barbetseas, John

doi:10.1016/j.hjc.2018.07.002

Cited by 11 publications

(14 citation statements)

References 28 publications

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“…The prevalence of TVD in these groups of patients has been variable, reported as high as 76%. 18,19 In our study, type B2 (46.2%) was the most common coronary lesion identified. In contrast, an earlier study showed that type C (66.9%) was the most common lesion identified in CKD patients under hemodialysis and that the low eGFR was observed to be a stronger marker of severity and complexity of angiographic lesions in CAD.…”

Section: Discussionmentioning

confidence: 49%

<p>Spectrum of Coronary Angiographic Findings in Potential Renal Transplant Recipients in a Tertiary Care Center of Nepal</p>

Yadav¹,

Jha²,

Gajurel³

et al. 2020

TRRM

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Background: Studies emphasizing the prevalence of coronary artery disease (CAD) and the diversity of coronary lesions among asymptomatic renal transplant recipients (RTRs) are few and far between in Nepal. Methods: In this cross-sectional observational study, a cohort of potential RTRs who were subjected to coronary angiography (CAG) as a part of both routine pre-op evaluation and therapeutic modality were enrolled and the spectrum of coronary angiographic lesions was reported. Significant CAD was defined by angiography as ≥70% stenosis. Percutaneous coronary intervention (PCI) was done for significant lesions. Results: A total of 60 patients (mean age: 53.7 ± 7.2 years, 43 males and 17 females) formed the subjects of the study. Diabetes was the commonest cause of ESRD (61.7%) with the mean duration of ESRD being 4.3 ± 2.2 years. Of the patients, 86.7% were routinely subjected to CAG and the remaining 13.3% presented with acute coronary syndrome. The right femoral artery was the most common access vessel (81.7%). CAD was present in 30/60 patients (50%). The left anterior descending artery was the most common culprit vessel (46.7%), followed by the left circumflex artery (38.3%). Among the routine CAG group, 42.3% had some form of CAD, the highest proportion of which was triple vessel disease (23.3%). Both double vessel disease and triple vessel disease were found to be highly prevalent in patients with hyperlipidemia, diabetes, and in smokers. The angiographic lesions were predominantly of discrete (41%), diffuse (35.9%), and eccentric (46.2%) types, had tandem arrangement (58.9%) with moderate angulation (56.4%), and were irregular (58.9%) in contour. A total of 3 ostial (7.7%) and 9 calcified (23.1%) lesions were found to be present. Chronic total occlusion and bifurcation lesions were observed in 4 (10.3%) and 5 (12.8%) cases, respectively. Six (15.4%) patients had well-developed collaterals. Twenty-one (53.8%) patients underwent PCI and 3 (7.7%) patients underwent coronary artery bypass surgery. Type B2 was the most common lesion (46.2%). Conclusion: Asymptomatic ESRD patients on the renal transplant list were found to have a high prevalence of CAD. CAG can be an efficient screening alternative for the detection of significant CAD among these patients.

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Section: Discussionmentioning

confidence: 49%

<p>Spectrum of Coronary Angiographic Findings in Potential Renal Transplant Recipients in a Tertiary Care Center of Nepal</p>

Yadav¹,

Jha²,

Gajurel³

et al. 2020

TRRM

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“…The incidence of CAD among renal transplant (RT) patients is higher than in the general population, ranging from 5–8%, with a cumulative incidence of 1.5% per year [ 7 ]. A recent study highlighted that one significantly calcified lesion was present in 75.7% of patients with RT vs. 15.8% of control patients on patients referred for coronary angiography [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Most studies have compared kidney transplantation with patients on dialysis awaiting a transplant, which is already a high-risk population [ 8 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Myocardial Infarction after Kidney Transplantation: A Risk and Specific Profile Analysis from a Nationwide French Medical Information Database

Didier¹,

Yao²,

Legendre³

et al. 2020

JCM

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Introduction: Renal transplant recipients have a high peri-operative risk for cardiovascular events. The post-transplantation period also carries a risk of myocardial infarction (MI). Coronary artery disease (CAD) is a leading cause of death in these patients. We aimed to assess the risk of MI, the specific morbidity profile of MI after transplantation as well as the long-term prognosis after MI in renal transplantation (RT) patients regarding cardiovascular (CV) death and all-cause death. Methods: From a French national medical information database, all of the patients seen in French hospitals in 2013 with at least 5-years follow-up were retrospectively identified and patients without transplantation but with previous dialysis at baseline were excluded. There were 17,526 patients with RT and 3,288,857 with no RT. Results: Among these patients, 1020 in the RT group (5.8%), and 93,320 in the non-RT group (2.8%) suffered acute MI during a median follow-up of 5.4 years. After multivariable adjustment, risk of MI was higher in RT patients than in non-RT patients (HR 1.45, IC 95% 1.35–1.55). The mean age was 59.5 years for transplant patients with MI, and 70.6 years for the reference population with MI (p < 0.0001). MI patients with RT (vs. non RT patients) were more likely to have hypertension, diabetes dyslipidemia, and peripheral artery disease (76.0% vs. 48.1%, 38.7% vs. 25.2%, 33.2% vs. 23.2%, and 31.2% vs. 17.3%, respectively, p < 0.0001). Incidence of non ST-elevation MI (NSTEMI) was higher in RT patients while incidence of ST-elevation MI (STEMI) was higher in patients without RT. In unadjusted analysis, risk of all-cause death and CV death within the first month after MI were higher in patients without RT (18% vs. 11.1% p < 0.0001 and 12.3% vs. 7.8%, p < 0.0001, respectively). However, multivariable analysis indicated that risk of all-cause death was higher in patients with RT than in those with no RT (adjusted HR 1.15 IC 95% 1.03–1.28). Conclusions: MI is not an uncommon complication after RT (incidence of around 5.8% after 5 years). RT is independently associated with a 45% higher risk of MI than in patients without RT, with a predominance of NSTEMI. MI in patients with RT is independently associated with a 15% higher risk of all-cause death than that in patients with MI and no RT.

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“…Both incidence and severity of coronary artery disease are more pronounced in patients suffering from chronic kidney disease (CKD) [1][2][3]. KTR often experienced long-term renal replacement therapy (RRT) while awaiting kidney transplantation with a known adverse impact on atherosclerotic burden and a high coincidence of cardiovascular risk factors such as diabetes or hypertension [1,4,5].…”

Section: Introductionmentioning

confidence: 99%

“…KTR often experienced long-term renal replacement therapy (RRT) while awaiting kidney transplantation with a known adverse impact on atherosclerotic burden and a high coincidence of cardiovascular risk factors such as diabetes or hypertension [1,4,5]. Even after successful transplantation, cardiovascular disease is highly prevalent in this population and the most frequent cause of death in KTR [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Incidence, risk factors and prognostic impact of acute kidney injury after coronary angiography and intervention in kidney transplant recipients: a single-center retrospective analysis

Lang

Patyna

Büttner

et al. 2020

pwki

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Introduction: Kidney transplant recipients (KTR) represent a high-risk population for cardiovascular disease. Coronary artery disease (CAD) is the most common cause of morbidity and mortality in this population. In KTR, coronary angiography and intervention (CI) can be associated with the risk of acute kidney injury (AKI). Aim: Data about the incidence and impact of AKI after CI in this population are rare. The aim of the present study is to describe the incidence and risk factors of AKI, periprocedural bleeding and the prognostic impact on 1-year mortality in KTR undergoing CI. Material and methods: This retrospective single-center study includes all KTR undergoing CI at University Hospital Frankfurt between 2005 and 2015. Results: A total of 135 CIs in KTR were analyzed. AKI occurred in 31 of 135 CIs (23%, AKI group). Patients of the AKI group were older; other baseline characteristics did not show significant differences. The amount of contrast dye used was higher in the AKI group (p = NS). Periprocedural bleeding defined by BARC criteria occurred more often in the AKI group (23% vs. 5%, p < 0.01) and persisted as a risk factor of AKI in multivariate analysis (odds ratio = 6.43, 95% CI: 1.78-23.20, p = 0.01). In-hospital mortality was 3% in the AKI group; no patient of the non-AKI group died during hospitalization (p = 0.2). One-year-survival was significantly higher in the non-AKI group (94% vs. 81%, p = 0.02). Conclusions: AKI is an important prognostic determinant in KTR undergoing coronary angiography and percutaneous coronary intervention (PCI). Periprocedural bleeding events were associated with AKI. Well-known risk factors for AKI such as contrast agent and diabetes were of minor impact.

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Coronary artery disease in renal transplant recipients: an angiographic study

Abstract: In this angiographic study, CAD was less severe in RT than in patients on long-term dialysis despite a longer duration of ESRD. Coronary artery calcification was highly prevalent after renal transplantation. PCI in RT had a high rate of angiographic success.

Cited by 11 publications

References 28 publications

<p>Spectrum of Coronary Angiographic Findings in Potential Renal Transplant Recipients in a Tertiary Care Center of Nepal</p>

<p>Spectrum of Coronary Angiographic Findings in Potential Renal Transplant Recipients in a Tertiary Care Center of Nepal</p>

Myocardial Infarction after Kidney Transplantation: A Risk and Specific Profile Analysis from a Nationwide French Medical Information Database

Incidence, risk factors and prognostic impact of acute kidney injury after coronary angiography and intervention in kidney transplant recipients: a single-center retrospective analysis

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