Cardiologist Evaluation and Approval Was the Primary Predictor of Kidney Transplant Candidacy and Transplantation Among Patients With Reduced Left Ventricular Ejection Fraction

Abstract

P revalence of left ventricular systolic dysfunction in patients with end-stage kidney disease (ESKD) is high, with an estimated 16% to 18% of ESKD patients affected in the literature. Of these, 60% had presumed nonischemic cardiomyopathy as diagnosed by the absence of myocardial ischemia on perfusion imaging. 1,2 Left ventricular systolic dysfunction is an independent risk factor for all-cause mortality in ESKD patients. 1 The pathophysiology of left ventricular dysfunction in ESKD is thought to relate to the uremic milieu leading to alterations in cardiac structure and function. The risk of uremic cardiomyopathy increases with time spent on dialysis 2 ; data from Medicare billing estimated the incidence of new-onset heart failure (HF) at 12.0% and 32.3% of patients at 12 and 36 mo after listing for kidney transplant,

Abdominal Organ Transplantation: Noteworthy Literature in 2023

“…1 In a retrospective study of 109 patients with left ventricular ejection fraction (LVEF) ≤ 40%, cardiologist denial of listing was the most significant predictor of transplant denial among indicators of significant cardiovascular disease (such as high troponin T or positive cardiac stress testing). 16 Cardiac event-free survival was lower for those denied transplant than those transplanted or still on the waitlist. However, despite cardiologist involvement in candidate selection, 5 of the 22 patients who ultimately received a kidney transplant among 109 initial cohort of patients experienced cardiac events or mortality after transplantation, highlighting the need for cautious screening in this population.…”