Preoperative Noncoronary Cardiovascular Assessment and Management of Kidney Transplant Candidates

Abstract

The pretransplant risk assessment for patients with ESKD who are undergoing evaluation for kidney transplant is complex and multifaceted. When considering cardiovascular disease in particular, many factors should be considered. Given the increasing incidence of kidney transplantation and the growing body of evidence addressing ESKD-specific cardiovascular risk profiles, there is an important need for a consolidated, evidence-based model that considers the unique cardiovascular challenges that these patients face. Cardiovascular physiology is altered in these patients by abrupt shifts in volume status, altered calcium-phosphate metabolism, high-output states (in the setting of arteriovenous fistulization), and adverse geometric and electrical remodeling, to name a few. Here, we present a contemporary review by addressing cardiomyopathy/heart failure, pulmonary hypertension, valvular dysfunction, and arrhythmia/sudden cardiac death within the ESKD population.

Standardized risk-stratified cardiac assessment and early posttransplant cardiovascular complications in kidney transplant recipients

“…Approximately 24% of patients without pretransplant CVD but with posttransplant MACE occurrence had pulmonary hypertension. The higher prevalence of pulmonary hypertension might be considered a prognostic factor for MACE in patients without pretransplant CVD, despite preserved myocardial kinetics ( 21 , 58 ). However, the rate of pulmonary hypertension did not reach statistical significance, probably due to the small number of patients whose endpoint was MACE occurrence ( Table 2 ).…”

“…The secondary endpoint was to evaluate the impact of pretransplant CVD detection and management on the incidence of MACE in the early posttransplant period and to specify the prognostic indicators of MACE. MACE was defined as the need for a revascularization procedure (PCI, CABG), symptomatic arrhythmia (atrial fibrillation/flutter) with the need for intervention (electrocardioversion, radiofrequency ablation), myocardial infarction, heart failure, and sudden death ( 20 , 21 ).…”