title: Validation of a screening protocol for identifying low-risk candidates with type 1 diabetes mellitus for kidney with or without pancreas transplantation.
abstract: BACKGROUND
  Certain clinical risk factors are associated with significant coronary artery disease in kidney transplant candidates with diabetes mellitus. We sought to validate the use of a clinical algorithm in predicting post-transplantation mortality in patients with type 1 diabetes. We also examined the prevalence of significant coronary lesions in high-risk transplant candidates.
  
  
  METHODS
  All patients with type 1 diabetes evaluated between 1991 and 2001 for kidney with/without pancreas transplantation were classified as high-risk based on the presence of any of the following risk factors: age >or=45 yr, smoking history >or=5 pack years, diabetes duration >or=25 yr or any ST-T segment abnormalities on electrocardiogram. Remaining patients were considered low risk. All high-risk candidates were advised to undergo coronary angiography. The primary outcome of interest was all-cause mortality post-transplantation.
  
  
  RESULTS
  Eighty-four high-risk and 42 low-risk patients were identified. Significant coronary artery stenosis was detected in 31 high-risk candidates. Mean arterial pressure was a significant predictor of coronary stenosis (odds ratio 1.68; 95% confidence interval 1.14-2.46), adjusted for age, sex and duration of diabetes. In 75 candidates who underwent transplantation with median follow-up of 47 months, the use of clinical risk factors predicted all eight deaths. No deaths occurred in low-risk patients. A significant mortality difference was noted between the two risk groups (p = 0.03).
  
  
  CONCLUSIONS
  This clinical algorithm can identify patients with type 1 diabetes at risk for mortality after kidney with/without pancreas transplant. Patients without clinical risk factors can safely undergo transplantation without further cardiac evaluation.
authors.affiliation: Division of Nephrology, Stanford University, CA, USA. ima@stanfordalumni.org
authors.forename: Irene W Y
authors.initials: IW
authors.lastname: Ma
authors.forename: Hannah A
authors.initials: HA
authors.lastname: Valantine
authors.forename: Atsuko
authors.initials: A
authors.lastname: Shibata
authors.forename: Jane
authors.initials: J
authors.lastname: Waskerwitz
authors.forename: Donald C
authors.initials: DC
authors.lastname: Dafoe
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Alfrey
authors.forename: Jane C
authors.initials: JC
authors.lastname: Tan
authors.forename: Maria
authors.initials: M
authors.lastname: Millan
authors.forename: Stephan
authors.initials: S
authors.lastname: Busque
authors.forename: John D
authors.initials: JD
authors.lastname: Scandling
mesh_terms: D017668:Age of Onset; D000704:Analysis of Variance; D002096:C-Peptide / Q000097:blood; D001026:Coronary Artery Bypass; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D015203:Reproducibility of Results; D012307:Risk Factors; D012907:Smoking
chemical_list: D002096:C-Peptide