Revascularization versus Medical Management of Coronary Artery Disease in Prerenal Transplant Patients: A Meta-Analysis

Abstract

Introduction: End-stage renal disease requiring renal transplantation comprises a growing patient population at risk for cardiovascular disease (CVD) morbidity and mortality in large part due to accelerated atherosclerosis. Consequently, these patients are at even higher risk of major surgical CVD mortality. A paucity of research has addressed the posttransplantation CVD outcomes related to different treatment strategies in this patient population and therefore, there are no specific preoperative guidelines regarding management of coronary artery disease in this high-risk population undergoing renal transplantation. Objective: Through meta-analysis we compare coronary revascularization to medical management prior to renal transplantation in patients who are found to have significant obstructive coronary artery disease. Results: A total of 6 studies were deemed suitable out of 777 articles reviewed. This included 260 patients who received medical management and 338 who received coronary revascularization. There were 36 events in the revascularization and 57 events in the medical management group. One study only reported hazard ratios but no CVD outcomes. Comprehensive Meta-Analysis software was used to calculate pooled odds ratio with 95% confidence intervals (CI) for the fixed effects. The data is presented as forest plots. The pooled odds ratio This work is sponsored in part by the Brooklyn Health Disparities Center NIH grant #P20 MD006875. DOI: 10.1159/000487763 193 Cardiorenal Med 20188:192-198 with 95% CI for the fixed effects was 1.415 (95% CI 0.885-2.263), p = 0.147, indicating that there is no difference in CVD outcomes between pretransplant treatment strategy. This observation suggests that the CVD outcomes posttransplantation are not affected when optimal medical therapy is used instead of coronary revascularization.

Treatment of ischemic heart disease in end-stage kidney disease patients on renal replacement therapy

“…Похожие результаты продемонстрировал метаана лиз 6 исследований, включивший 260 кандидатов на трансплантацию почки, получавших медикаментоз ное лечение ИБС, и 338 пациентов, которым была проведена коронарная реваскуляризация. Анализ не показал значимых различий в сердечнососудис тых исходах между группами (ОШ 1,415, 95% ДИ 0,885-2,263) [19].…”

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

“…Kamran et al [ 68 ] conducted a meta-analysis of six studies comparing revascularisation versus medical management of stable obstructive CAD in prerenal transplant patients. They found no difference in post-transplantation cardiovascular outcomes between the two strategies.…”