Role of Coronary Angiography in the Assessment of Cardiovascular Risk in Kidney Transplant Candidates

Mann, David; Fernandez, Sonalis; Mondal, Zahidul; Laskow, David A.; Osband, Adena J.; DebRoy, Meelie; Lebowitz, Jonathan; Coromilas, James; Vagaonescu, Tudor; Moreyra, Abel E.; Melita, Elizabeth A.; Mann, Richard A.

doi:10.1016/j.amjcard.2016.06.017

Cited by 19 publications

(15 citation statements)

References 29 publications

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“…In one study of kidney transplant candidates with cardiovascular risk factors other than HIV/HCV, the positive and negative predictive values of noninvasive means in detecting clinically significant cardiovascular disease were only 43% and 47%, respectively. Furthermore, mortality was reduced in those who underwent elective revascularization pretransplantation [29]. At our institution, following this case, we have a very low threshold for coronary angiography in HIV-infected or HCV-infected transplant candidates with a history of significant CAD, regardless of reported symptoms.…”

Section: Discussionmentioning

confidence: 88%

“…Cardiovascular disease and rates of myocardial infarction are already increased in patients with ESRD [29], but possibly further potentiated by HIV/HCV coinfection [30], by way of chronic inflammation, endothelial dysfunction, metabolic derangements [30][31][32][33][34], and potential choice of antiretroviral therapy [35]. Assessing cardiovascular risk in the pretransplant evaluation is imperative.…”

Section: Discussionmentioning

confidence: 99%

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Successful Kidney Transplantation in a Recipient Coinfected with Hepatitis C Genotype 2 and HIV from a Donor Infected with Hepatitis C Genotype 1 in the Direct-Acting Antiviral Era

Farmakiotis

Weiss

Brotherton

et al. 2020

Case Reports in Hepatology

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Despite significant advances in transplantation of HIV-infected individuals, little is known about HIV coinfected patients with hepatitis C virus (HCV) genotypes other than genotype 1, especially when receiving HCV-infected organs with a different genotype. We describe the first case of kidney transplantation in a man coinfected with hepatitis C and HIV in our state. To our knowledge, this is also the first report of an HIV/HCV/HBV tri-infected patient with non-1 (2a) HCV genotype who received an HCV-infected kidney graft with the discordant genotype (1a), to which he converted after transplant. Our case study highlights the following: (1) transplant centers need to monitor wait times for an HCV-infected organ and regularly assess the risk of delaying HCV antiviral treatment for HCV-infected transplant candidates in anticipation of the transplant from an HCV-infected donor; (2) closer monitoring of tacrolimus levels during the early phases of anti-HCV protease inhibitor introduction and discontinuation may be indicated; (3) donor genotype transmission can occur; (4) HIV/HCV coinfected transplant candidates require a holistic approach with emphasis on the cardiovascular risk profile and low threshold for cardiac catheterization as part of their pretransplant evaluation.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Successful Kidney Transplantation in a Recipient Coinfected with Hepatitis C Genotype 2 and HIV from a Donor Infected with Hepatitis C Genotype 1 in the Direct-Acting Antiviral Era

Farmakiotis

Weiss

Brotherton

et al. 2020

Case Reports in Hepatology

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“…The presence of diabetes, peripheral arterial disease, and prior myocardial infarction were independently associated with angiographically significant CAD, and the composite incidence of fatal/nonfatal MACE increased almost two-fold in patients with diabetes, four-fold in patients with peripheral arterial disease, and six-fold in patients with prior MI. (65) Recently, Mann et al (66) studied high-risk renal transplant candidates (N=225) defined by the presence of diabetes, known CAD, peripheral arterial disease, or ischemia on MPI. Coronary angiography revealed significant CAD in 47% of high-risk patients; furthermore, percutaneous or surgical revascularization in patients with ≥ 70% coronary stenosis resulted in reduced mortality both for those on the waiting list and for those who underwent renal transplantation.…”

Section: Coronary Angiographymentioning

confidence: 99%

“…Coronary angiography revealed significant CAD in 47% of high-risk patients; furthermore, percutaneous or surgical revascularization in patients with ≥ 70% coronary stenosis resulted in reduced mortality both for those on the waiting list and for those who underwent renal transplantation. (66)…”

Section: Coronary Angiographymentioning

confidence: 99%

Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

Golzar

Doukky

2017

Curr Cardiovasc Imaging Rep

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Purpose of Review Patients with end-stage renal disease (ESRD) have an increased risk of cardiovascular morbidity and mortality. Cardiac risk assessment, though challenging, is critical in these high-risk patients, particularly in the pre-transplant population. In this review, we discuss the burden of coronary artery disease in the ESRD population and review the literature on the diagnostic and prognostic performance, clinical value, and future directions of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in ESRD patients. Recent Findings Stress myocardial perfusion imaging provides incremental prognostic value to clinical data. The AHA/ACCF consensus statement on the cardiac assessment of kidney transplant candidates provides some guidance on the selection of asymptomatic patients for further non-invasive risk stratification. Additionally, the novel selective A2A receptor agonist vasodilator stress agent, regadenoson, is safe and effective in ESRD and has recently been approved by the Food and Drug Administration for use in this population. Ancillary stress MPI findings, namely heart rate response to vasodilator stress, can provide incremental risk stratification. Summary While myocardial perfusion imaging is widely used as a risk assessment tool, its utilization and clinical implications in the ESRD population are controversial. Though stress SPECT-MPI has imperfect diagnostic accuracy in this specific patient population, it is still a valuable non-invasive modality in cardiovascular risk assessment.

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“…Unfortunately, its use in advanced CKD patients/KT candidates—especially in those not yet requiring dialysis—is restricted due to the application of iodinated contrast media. Although similar reservations exist concerning the use of invasive CAG, it is still the best predictor of adverse events in renal transplant candidates [ 19 , 20 ]. Furthermore, it allows for immediate revascularization of critical coronary lesions when indicated.…”

Section: Introductionmentioning

confidence: 99%

Impact of cardiovascular risk stratification strategies in kidney transplantation over time

Deak

Ionita

Kirsch

et al. 2020

Nephrology Dialysis Transplantation

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Background Kidney transplant recipients exhibit a dramatically increased cardiovascular (CV) risk. In 2007, Austrian centres implemented a consensus of comprehensive CV screening programme prior to kidney transplantation (KT). The consensus placed a particular emphasis on screening for coronary artery disease (CAD) with cardiac computed tomography (CT) or coronary angiography (CAG) in patients with diabetes mellitus, known CAD or those having multiple conventional CV risk factors. Here, we investigate if this affected risk stratification and post-transplant CV outcomes. Methods In a retrospective chart review, we evaluated 551 KTs performed from 2003 to 2015 in our centre. Patients were categorized into three groups: KT before (2003–07), directly after (2008–11) and 5 years after (2012–15) implementation of the consensus. We analysed clinical characteristics, the rate of cardiac CTs and CAGs prior to KT as well as major adverse cardiac events (MACEs) during a 2-year follow-up after KT. Results The three study groups showed a homogeneous distribution of comorbidities and age. Significantly more cardiac CTs (13.6% versus 10.2% versus 44.8%; P = 0.002) and CAGs (39.6% versus 43.9% versus 56.2%; P = 0.003) were performed after the consensus. Coronary interventions were performed during 42 out of 260 CAGs (16.2%), the cumulative 2-year MACE incidence was 8.7%. Regarding MACE occurrence, no significant difference between the three groups was found. Conclusion CV risk stratification has become more rigorous and invasive after the implementation of the consensus; however, this was not associated with an improvement in CV outcome.

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Role of Coronary Angiography in the Assessment of Cardiovascular Risk in Kidney Transplant Candidates

Cited by 19 publications

References 29 publications

Successful Kidney Transplantation in a Recipient Coinfected with Hepatitis C Genotype 2 and HIV from a Donor Infected with Hepatitis C Genotype 1 in the Direct-Acting Antiviral Era

Successful Kidney Transplantation in a Recipient Coinfected with Hepatitis C Genotype 2 and HIV from a Donor Infected with Hepatitis C Genotype 1 in the Direct-Acting Antiviral Era

Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

Impact of cardiovascular risk stratification strategies in kidney transplantation over time

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