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. 2023 Feb 1;183(2):134-141.
doi: 10.1001/jamainternmed.2022.6069.

Association of Pretransplant Coronary Heart Disease Testing With Early Kidney Transplant Outcomes

Xingxing S Cheng  1 , Sai Liu  1 , Jialin Han  1 , Margaret R Stedman  1 , Michael Baiocchi  2 , Jane C Tan  1 , Glenn M Chertow  1 , William F Fearon  3
Affiliations

Association of Pretransplant Coronary Heart Disease Testing With Early Kidney Transplant Outcomes

Xingxing S Cheng et al. JAMA Intern Med. .

Erratum in

  • Errors in Abstract and Results.
    [No authors listed] [No authors listed] JAMA Intern Med. 2023 Apr 1;183(4):394. doi: 10.1001/jamainternmed.2023.0033. JAMA Intern Med. 2023. PMID: 36808183 Free PMC article. No abstract available.

Abstract

Importance: Testing for coronary heart disease (CHD) in asymptomatic kidney transplant candidates before transplant is widespread and endorsed by various professional societies, but its association with perioperative outcomes is unclear.

Objective: To estimate the association of pretransplant CHD testing with rates of death and myocardial infarction (MI).

Design, setting, and participants: This retrospective cohort study included all adult, first-time kidney transplant recipients from January 2000 through December 2014 in the US Renal Data System with at least 1 year of Medicare enrollment before and after transplant. An instrumental variable (IV) analysis was used, with the program-level CHD testing rate in the year of the transplant as the IV. Analyses were stratified by study period, as the rate of CHD testing varied over time. A combination of US Renal Data System variables and Medicare claims was used to ascertain exposure, IV, covariates, and outcomes.

Exposures: Receipt of nonurgent invasive or noninvasive CHD testing during the 12 months preceding kidney transplant.

Main outcomes and measures: The primary outcome was a composite of death or acute MI within 30 days of after kidney transplant.

Results: The cohort comprised 79 334 adult, first-time kidney transplant recipients (30 147 women [38%]; 25 387 [21%] Black and 48 394 [61%] White individuals; mean [SD] age of 56 [14] years during 2012 to 2014). The primary outcome occurred in 4604 patients (244 [5.3%]; 120 [2.6%] death, 134 [2.9%] acute MI). During the most recent study period (2012-2014), the CHD testing rate was 56% in patients in the most test-intensive transplant programs (fifth IV quintile) and 24% in patients at the least test-intensive transplant program (first IV quintile, P < .001); this pattern was similar across other study periods. In the main IV analysis, compared with no testing, CHD testing was not associated with a change in the rate of primary outcome (rate difference, 1.9%; 95% CI, 0%-3.5%). The results were similar across study periods, except for 2000 to 2003, during which CHD testing was associated with a higher event rate (rate difference, 6.8%; 95% CI, 1.8%-12.0%).

Conclusions and relevance: The results of this cohort study suggest that pretransplant CHD testing was not associated with a reduction in early posttransplant death or acute MI. The study findings potentially challenge the ubiquity of CHD testing before kidney transplant and should be confirmed in interventional studies.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cheng reported grants from the American Heart Association during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Assembly of Instrument Variable (IV) and Study Cohorts
KTx indicates kidney transplant.
Figure 2.
Figure 2.. Association of Pretransplant Coronary Heart Disease (CHD) Testing With Death or Acute Myocardial Infarction Rate Within 30 Days Posttransplant
See this image and copyright information in PMC

Comment in

References

    1. Lentine KL, Costa SP, Weir MR, et al. ; American Heart Association Council on the Kidney in Cardiovascular Disease and Council on Peripheral Vascular Disease . Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol. 2012;60(5):434-480. doi:10.1016/j.jacc.2012.05.008 - DOI - PubMed
    1. Lentine KL, Schnitzler MA, Brennan DC, et al. . Cardiac evaluation before kidney transplantation: a practice patterns analysis in Medicare-insured dialysis patients. Clin J Am Soc Nephrol. 2008;3(4):1115-1124. doi:10.2215/CJN.05351107 - DOI - PMC - PubMed
    1. Shpigel AA, Saeed MJ, Novak E, Alhamad T, Rich MW, Brown DL. Center-related variation in cardiac stress testing in the 18 months prior to renal transplantation. JAMA Intern Med. 2019;179(8):1135-1136. doi:10.1001/jamainternmed.2019.0423 - DOI - PMC - PubMed
    1. Cheng XS, Liu S, Han J, et al. . Trends in coronary artery disease screening before kidney transplantation. Kidney360. 2021;3(3):516-523. doi:10.34067/KID.0005282021 - DOI - PMC - PubMed
    1. McFalls EO, Ward HB, Moritz TE, et al. . Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351(27):2795-2804. doi:10.1056/NEJMoa041905 - DOI - PubMed

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