Pre‐transplant cardiac testing for kidney–pancreas transplant candidates and association with cardiac outcomes

Lin, Karen; Stewart, D.; Cooper, Stephanie; Davis, Connie L.

doi:10.1034/j.1399-0012.2001.150409.x

Cited by 34 publications

(18 citation statements)

References 21 publications

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“…There are, however, several single-center cohort studies of asymptomatic "low-risk" CKD patients (age <50 y, no diabetes, no history of CV disease), in which a high predictive value of ECG and chest X-ray for CV risk assessment was confirmed [13,28,37], and in which no other screening tests were performed before KT.…”

Section: Discussionmentioning

confidence: 98%

Dobutamine Stress Echocardiography in the Diagnosis of Asymptomatic Ischemic Heart Disease in Patients With Chronic Kidney Disease—Review of Literature and Single-Center Experience

Januszko‐Giergielewicz

Dębska-Ślizień

Górny

et al. 2015

Transplantation Proceedings

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Section: Discussionmentioning

confidence: 98%

Dobutamine Stress Echocardiography in the Diagnosis of Asymptomatic Ischemic Heart Disease in Patients With Chronic Kidney Disease—Review of Literature and Single-Center Experience

Januszko‐Giergielewicz

Dębska-Ślizień

Górny

et al. 2015

Transplantation Proceedings

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“…Historically, angiocardiography was recommended for cardiac assessment; however, with the emergence of more sophisticated radiological cardiac imaging modalities, there has been a trend away from this invasive investigation. Stress echocardiography has also been used for cardiac stratification , while in our unit the mainstay of pretransplant assessment is myocardial perfusion scanning, as it offers the advantage of sensitive and detailed functional assessment in these high‐risk patients.…”

Section: Discussionmentioning

confidence: 99%

An analysis of the association between older recipient age and outcomes after whole‐organ pancreas transplantation – a single‐centre, retrospective study

Mittal

Smilevska²,

Franklin

et al. 2020

Transpl Int

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Summary Older people are increasingly being referred for consideration for pancreas transplantation (PT). We investigated the outcomes after PT in our older recipient cohort. A prospectively maintained database was interrogated. The cohort was analysed for associations between outcome and older recipient age. A total of 444 transplants were performed in patients aged 23–54 years and 83 transplants in patients aged 55–67 years. There was no difference in death‐censored pancreas or kidney graft survival between the groups. Patient death was associated with older recipient age (HR 1.63 per 10‐year increase). In multivariate Cox regression, risk of mortality was also associated with post‐transplant myocardial infarction (HR 7.25, P = 0.006), pancreas failure (HR 1.91, P = 0.003) and kidney failure (HR 3.55, P < 0.001). About 40% of recipients who died in the first year post‐transplant suffered early graft loss. Those alive at a year post‐transplant had inferior survival if they had lost their kidney graft (P < 0.001). Mortality is higher in older patients and is strongly associated with pancreas and kidney graft failure. This suggests that pancreas transplantation is feasible in older recipients, and careful selection of donor organs is important to optimize survival.

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“…Nevertheless, 20% of subjects with negative dobutamine stress echocardiography results followed for 22 months reached a cardiac end point (12). In fact, a study in kidneypancreas transplant candidates found that most cardiac events occurred in individuals with negative results of noninvasive tests (32). Therefore, intensive medical therapy was recommended for all subjects with any angiographic evidence of CAD.…”

Section: Prediction Of a Low-risk Subgroupmentioning

confidence: 99%

Coronary Artery Disease Is Common in Nonuremic, Asymptomatic Type 1 Diabetic Islet Transplant Candidates

Senior

Welsh²,

McDonald³

et al. 2005

Diabetes Care

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OBJECTIVE -Coronary artery disease (CAD) is the most common cause of death in patients with type 1 diabetes. Asymptomatic CAD is common in uremic diabetic patients, but its prevalence in nonuremic type 1 diabetic patients is unknown. The prevalence of CAD was determined by coronary angiography and the performance of noninvasive cardiac investigation evaluated in type 1 diabetic islet transplant (ITX) candidates with preserved renal function. RESEARCH DESIGN AND METHODS-A total of 60 consecutive type 1 diabetic ITX candidates (average age 46 years [mean 24 -64], 23 men, and 47% ever smokers) underwent coronary angiography, electrocardiographic stress testing (EST), and myocardial perfusion imaging (MPI) in a prospective cohort study. CAD was indicated on angiography by the presence of stenoses Ͼ50%. Models to predict CAD were examined by logistic regression.RESULTS -Most subjects (53 of 60) had no history or symptoms of CAD; 23 (43%) of these asymptomatic subjects had stenoses Ͼ50%. CAD was associated with age, duration of diabetes, hypertension, and smoking. Although specific, EST and MPI were not sensitive as predictors of CAD on angiography (specificity 0.97 and 0.93, sensitivity 0.17 and 0.04, respectively) but helped identify two of three subjects requiring revascularization. EST and MPI did not enhance logistic regression models. A clinical algorithm to identify low-risk subjects who may not require angiography was highly sensitive but was applicable only to a minority (n ϭ 8, sensitivity 1.0, specificity 0.27, negative predictive value 1.0).CONCLUSIONS -Nonuremic type 1 diabetic patients with hypoglycemic unawareness and/or metabolic lability referred for ITX are at high risk for asymptomatic CAD despite negative noninvasive investigations. Aggressive management of cardiovascular risk factors and further investigation into optimal cardiac risk stratification in type 1 diabetes are warranted. Diabetes Care 28:866 -872, 2005T ype 1 diabetes is associated with a more than threefold increase in mortality compared with that in the general population, mainly due to cardiovascular disease (1). Clinical assessment and management of this high-risk population are challenging because they frequently have multiple cardiovascular risk factors, suffer from comorbid diseases, and may lack typical symptoms of ischemia (silent myocardial ischemia and infarction).Islet transplantation (ITX) can cure hypoglycemia and stabilize glycemia and may be indicated for type 1 diabetic patients with severe hypoglycemia (usually with hypoglycemia unawareness) and metabolic lability despite optimal therapy (2). The nephrotoxicity of immunosuppressants excludes those with significant renal impairment. Most ITX candidates have long-standing diabetes and many have neuropathy. Diabetes per se, a long duration of diabetes (3), and autonomic neuropathy (4) are risk factors for coronary artery disease (CAD), which may be asymptomatic (5-7). Furthermore, the long-term impact of ITX on CAD is unknown.Current data indicating a high prevalence of ...

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Pre‐transplant cardiac testing for kidney–pancreas transplant candidates and association with cardiac outcomes

Cited by 34 publications

References 21 publications

Dobutamine Stress Echocardiography in the Diagnosis of Asymptomatic Ischemic Heart Disease in Patients With Chronic Kidney Disease—Review of Literature and Single-Center Experience

Dobutamine Stress Echocardiography in the Diagnosis of Asymptomatic Ischemic Heart Disease in Patients With Chronic Kidney Disease—Review of Literature and Single-Center Experience

An analysis of the association between older recipient age and outcomes after whole‐organ pancreas transplantation – a single‐centre, retrospective study

Coronary Artery Disease Is Common in Nonuremic, Asymptomatic Type 1 Diabetic Islet Transplant Candidates

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