title: Pre-transplant cardiac testing for kidney-pancreas transplant candidates and association with cardiac outcomes.
abstract: BACKGROUND
  Coronary artery disease is a major cause of mortality following renal transplantation, especially in those patients with diabetes. The accurate prediction of cardiac risk is therefore a major focus of the pre-transplant evaluation. The objective of this study was to retrospectively evaluate the ability of non-invasive cardiac testing (standard echocardiography, stress echocardiography, exercise tolerance testing, and nuclear myocardial perfusion) performed within 1 yr of kidney-pancreas transplant to predict post-transplant myocardial infarction.
  
  
  METHODS
  Clinical history and pre-transplant cardiac testing performed within 1 yr prior to transplantation were reviewed in a non-blinded fashion for 165 kidney-pancreas transplantation patients receiving allografts between June 1990 and May 1998. The predictive values of clinical symptoms and cardiac testing for cardiac events (fatal and non-fatal myocardial infarctions) up to 1 yr post-transplant were calculated.
  
  
  RESULTS
  Clinical history had a negative predictive value of 98% for cardiac events occurring within 1 yr following testing and 97% within 1 yr post-transplant. Collectively, non-invasive testing had a negative predictive value of 97% for 1 yr post-testing and 1 yr post-transplant.
  
  
  CONCLUSIONS
  Clinical history alone is highly suggestive but not sufficient for the prediction of post-kidney-pancreas transplant myocardial infarction. Although a useful supplement, cardiac testing does not predict all cardiac events out to 1 yr post-testing. In this high-risk patient population with diabetes and renal failure, other methods of risk assessment are needed to more accurately predict long-term cardiac outcome for patients awaiting transplantation.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA. cdavis@u.washongton.edu
authors.forename: K
authors.initials: K
authors.lastname: Lin
authors.forename: D
authors.initials: D
authors.lastname: Stewart
authors.forename: S
authors.initials: S
authors.lastname: Cooper
authors.forename: C L
authors.initials: CL
authors.lastname: Davis
mesh_terms: D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology; D025401:Echocardiography, Stress; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D017211:Treatment Failure