Screening for cardiovascular disease before kidney transplantation

Abstract

Pre-kidney transplant cardiac screening has garnered particular attention from guideline committees as an approach to improving post-transplant success. Screening serves two major purposes: To more accurately inform transplant candidates of their risk for a cardiac event before and after the transplant, thereby informing decisions about proceeding with transplantation, and to guide pre-transplant management so that post-transplant success can be maximized. Transplant candidates on dialysis are more likely to be screened for coronary artery disease than those not being considered for transplantation. Thorough history and physical examination taking, resting electrocardiography and echocardiography, exercise stress testing, myocardial perfusion scintigraphy, dobutamine stress echocardiography, cardiac computed tomography, cardiac biomarker measurement, and cardiac magnetic resonance imaging all play contributory roles towards screening for cardiovascular disease before kidney transplantation. In this review, the importance of each of these screening procedures for both coronary artery disease and other forms of cardiac disease are discussed.

Keywords: Chronic kidney disease; Coronary angiography; Dobutamine stress echocardiography; Magnetic resonance imaging; Myocardial perfusion scanning.

Figure 1

Suggested pre-transplant screening algorithm for cardiovascular disease. ¹Diabetes mellitus, prior CVD, > 1 year on dialysis, LVH, age > 60 years, smoking, hypertension, and dyslipidemia; ²Proceed to transplantation with standard screening and frequency of testing [for patients with no abnormalities at start, standard frequency is evaluation once dry weight is achieved (1-3 mo) and prior to transplantation date]; ³Abnormalities that pose limited threat to the success of the allograft and patient’s health; ⁴Per cardiologist recommendation. CVD: Cardiovascular disease; MPS: Myocardial perfusion scintigraphy; DSE: Dobutamine stress echocardiography; LVH: Left ventricular hypertrophy; METS: Metabolic equivalents.