Renal transplant outcome in high‐cardiovascular risk recipients

Jeloka, Tarun; Ross, Heather J.; Smith, Robert; Huang, Michael; Fenton, Stanley; Cattran, Daniel C.; Schiff, Jeffrey; Cardella, Carl J.; Cole, Edward

doi:10.1111/j.1399-0012.2007.00695.x

Cited by 40 publications

(28 citation statements)

References 11 publications

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“…16 Diffuse atherosclerosis and microvascular dysfunction may partially explain why the association between elevated LDL cholesterol and myocardial infarction is attenuated in patients with advanced CKD 17 and may also help us understand previously observed discrepancies between traditional cardiovascular risk assessment and outcomes after renal transplantation. 18 Additional studies are needed to determine whether longitudinal improvement in global CFR is associated with risk reduction. If that can be shown, it may be appropriate to use global CFR as a surrogate for mortality in future clinical trials involving patients with dd-ESRD.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Coronary Flow Reserve in Patients with Dialysis-Dependent ESRD

Shah

Charytan²,

Murthy

et al. 2015

JASN

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Capillary rarefaction of the coronary microcirculation is a consistent phenotype in patients with dialysisdependent ESRD (dd-ESRD) and may help explain their excess mortality. Global coronary flow reserve (CFR) assessed by positron emission tomography (PET) is a noninvasive, quantitative marker of myocardial perfusion and ischemia that integrates the hemodynamic effects of epicardial stenosis, diffuse atherosclerosis, and microvascular dysfunction. We tested whether global CFR provides risk stratification in patients with dd-ESRD. Consecutive patients with dd-ESRD clinically referred for myocardial perfusion PET imaging were retrospectively included, excluding patients with prior renal transplantation. Perpatient CFR was calculated as the ratio of stress to rest absolute myocardial blood flow. Multivariable Cox proportional hazards models, including age, overt cardiovascular disease, and myocardial scar/ischemia burden, were used to assess the independent association of global CFR with all-cause and cardiovascular mortality. The incremental value of global CFR was assessed with relative integrated discrimination index and net reclassification improvement. In 168 patients included, median global CFR was 1.4 (interquartile range, 1.2-1.8). During follow-up (median of 3 years), 36 patients died, including 21 cardiovascular deaths. Log-transformed global CFR independently associated with all-cause mortality (hazard ratio, 0.01 per 0.5-unit increase; 95% confidence interval, ,0.01 to 0.14; P,0.001) and cardiovascular mortality (hazard ratio, 0.01 per 0.5-unit increase; 95% confidence interval, ,0.01 to 0.15; P=0.002). For all-cause mortality, addition of global CFR resulted in risk reclassification in 27% of patients. Thus, global CFR may provide independent and incremental risk stratification for all-cause and cardiovascular mortality in patients with dd-ESRD.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Coronary Flow Reserve in Patients with Dialysis-Dependent ESRD

Shah

Charytan²,

Murthy

et al. 2015

JASN

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“…Jeloka et al 35 retrospectively classified 429 renal transplant recipients as high cardiovascular risk (nϭ61) and low cardiovascular risk (nϭ368). The high-risk group included patients with a history of angina, MI, or significant CAD found on cardiac catheterization.…”

Section: What Are the Goals Of Preoperative Cardiac Risk Evaluation Imentioning

confidence: 99%

Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates

Lentine¹,

Costa²,

Weir³

et al. 2012

Circulation

280

159

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“…This finding suggested that significant CAD was a predictor of future cardiovascular events [18]. In another study, post-transplantation cardiac events and survival were reported to be 31.3% and 82.8% in high-risk patients, whereas it was 6.5% and 93.1% in low risk patients [19]. However, the study by Gowdak et al showed that in the overall population for each 100 CAG performed, there would be 55 patients with no significant CAD and 10 cardiovascular events associated with it [18].…”

Section: Epidemiologymentioning

confidence: 95%

Cardiovascular Evaluation of Renal Transplant Recipients

Gülmez¹

2017

J Clin Exp Cardiolog

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Cardiovascular disease (CVD) is one of the major causes of death among renal transplant recipients. Moreover, several prospective studies among renal transplant recipients showed that increased incidence of CVD is still present after transplantation. Therefore, evaluation for the presence of CVD before transplantation is strongly advised. Although several screening tests are used for the detection of CVD, the relative performance of these tests for coronary artery disease (CAD) is uncertain. This review discusses the definition, risk factors, epidemiology, and the most used screening tests that might help cardiologists in providing information about the diagnosis and risk stratification before renal transplantation.

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Renal transplant outcome in high‐cardiovascular risk recipients

Abstract: Post-transplant survival of high-CV risk patients (with known CAD) is lower than that of low-risk recipients but remains acceptable. Cardiac interventions may reduce perioperative risk but do not reduce the probability of post-transplant cardiac events to that of low-risk group.

Cited by 40 publications

References 11 publications

Prognostic Value of Coronary Flow Reserve in Patients with Dialysis-Dependent ESRD

Prognostic Value of Coronary Flow Reserve in Patients with Dialysis-Dependent ESRD

Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates

Cardiovascular Evaluation of Renal Transplant Recipients

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