Pretransplant cardiac investigations in the Irish renal transplant population--the effectiveness of our current screening techniques in predicting cardiac events.
BACKGROUND
Coronary artery disease (CAD) is prevalent among endstage renal failure patients and remains the major cause of mortality following renal transplantation. Death with a functioning transplant institute remains the most common cause of kidney graft failure. In this study we attempt to evaluate the effectiveness of the clinical history and current screening techniques available in predicting posttransplant CAD and also assess the role of coronary angiography as a pretransplant screening technique.


METHODS
Clinical data of 190 renal transplant patients was analyzed. Any clinical history of cardiac disease and all preoperative cardiac screening data was recorded for each patient. The study endpoints were the subsequent development of myocardial infarction (MI), undergoing coronary artery bypass graft (CABG) or death.


RESULTS
Factors that were significantly associated with reaching a study endpoint included: age at transplant [Hazard Ratio (HR) 1.91, P<0.001], history of heart failure (HR 8.22, P<0.001), presence of CAD on coronary angiography (HR 5.55, P=0.033), anterior Q wave on electrocardiograph (ECG) (HR 8.6, P<0.001), carotid artery disease (HR 3.74, P=0.030) and history of a cerebrovascular accident (HR of 4.32, P=0.008). The screening techniques of exercise stress testing and echocardiography were not conclusive as predictive variables of outcome.


CONCLUSIONS
Clinical history and ECG results are good, practical and low-cost screening methods. In our study exercise stress testing and echocardiography were found to be of limited value. Coronary angiography is appropriate in certain high-risk groups but not necessary as part of screening in all potential renal transplant recipients.
Department of Renal Transplantation, Beaumont Hospital, Dublin, Ireland.
Mohammed
M
Ali
Louise
L
Giblin
K
K
Farhad
Patrick
P
O'Kelly
David
D
Hickey
Dilly
D
Little
John
J
Donohoe
Joseph J
JJ
Walshe
Peter J
PJ
Conlon
D000293:Adolescent; D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies