#3368 Diagnostic Yield and Clinical Significance of Systematic Cardiac Screening of Kidney Transplant Candidates Using Cardiac Computed Tomography

Abstract

Background and Aims Cardiovascular screening of kidney transplant candidates is currently recommended, although the patient value is presently questioned. The prognostic ability is known, whereas systematic screening may have less recognized effects such as incidental findings, triggering of additional investigations, procedural complications, delay of transplantation and deselection of patients for kidney transplantation. To address this, we characterized the diagnostic yield and clinical implications of systematic screening for cardiovascular disease using cardiac computed tomography (CT) in asymptomatic kidney transplant candidates. Method In a single-centre, observational study, we included all potential kidney transplant candidates ≥ 40 years or with diabetes or on dialysis treatment ≥ 5 years, who were systematically referred to cardiac CT (a non-contrast enhanced CT scan and a coronary CT angiography) prior to kidney transplantation between March 2014 and September 2019 in North and Central Denmark Regions. Patient records were examined to obtain data on baseline characteristics, additional investigations, incidental findings, conference decisions. Results In total, 473 patients underwent cardiac CT. The screening programme led to additional cardiac investigations in 155 patients (33%) and 7% were revascularised. Thirty patients (6%) had significant incidental non-vascular findings on cardiac CT, but only 4 patients were changed in medical management based on these findings. Furthermore, no patients were rejected for transplantation based on the cardiac CT. In patients not yet on dialysis, the slope in eGFR decline did not change significantly after coronary CT angiography. Conclusion The clinical significance of the screening by cardiac CT was limited, and one third of patients had to go through additional investigations. Few patients were revascularised and no patients rejected for transplantation. No evidence of contrast-induced acceleration of kidney function decline was observed.