Extent and Severity of Coronary Disease and Mortality in Patients with End-Stage Renal Failure Evaluated for Renal Transplantation

Abstract

The purpose of this study is to explore the relationship between coronary artery disease (CAD), transplantation status and subsequent mortality in end-stage renal disease (ESRD) patients undergoing evaluation for renal transplantation. Two hundred fifty-three ESRD patients at high risk for CAD underwent coronary angiography as part of a renal transplant evaluation. The cohort was divided into three groups: Group 1 (n = 127) had no vessels with ≥50% stenosis, Group 2 (n = 56) had one vessel with ≥50% stenosis and Group 3 (n = 70) had two or more vessels with ≥50% stenosis. Long-term survival was determined; median follow-up was 3.3 years. The baseline characteristics were similar except for older age and higher proportion of diabetes mellitus, dyslipidemia and peripheral vascular disease in Groups 2 and 3 patients as compared to Group 1. Survival was worse in Group 3 compared to Group 1 (p < 0.0001). Each of the three subgroups had better survival with renal transplantation than those who did not undergo transplantation (p < 0.0001). Although the degree of CAD is related to subsequent mortality, transplantation is associated with better survival regardless of the extent and severity of CAD. Thus, the presence of CAD should not exclude ESRD patients from consideration for this therapy.

Traditional and Nontraditional Cardiovascular Risk Factors and Estimated Risk for Coronary Artery Disease in Renal Transplant Recipients: A Single-Center Experience

“…Compared to dialysis patients, a reduction of the rate of cardiac death after successful renal transplantation has been reported [12,13]. However, cardiovascular death is still a major problem after transplantation.…”

Cardiovascular Evaluation of Renal Transplant Recipients

“…Although coronary stenosis were the strongest predictor of cardiac events at 48 months (event-free survival 94% in patients without significant CAD vs. 54% in patients with critical CAD), it was shown that renal transplantation was associated with better survival regardless of the degree of coronary disease [42,43]. On the other hand, nonsignificant stenosis may progress while the patient is on the waiting list.…”

Screening for cardiovascular disease before kidney transplantation

“…Published guidelines typically are authored only from certain countries and are based largely on the population characteristics of those countries, and so it is important for transplant centres to recognize their own unique dialysis and general population characteristics, then customdesign their approach to diagnostic testing accordingly. Despite no clear message provided by the literature on the effectiveness of coronary angiography at ultimately reducing posttransplant mortality, clinicians can be comforted by the finding that transplantation may be associated with better survival in all candidates regardless of CAD severity [47] .…”