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Kidney Week

Abstract: TH-PO161

Role of Coronary Interventions in High Cardiovascular Risk Patients on Kidney Transplant Waitlist

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Klaud francheska, Bayiha daho, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Fernandez, Maria, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Salha, Ahmad, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Lowe-Jones, Racquel M., St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Banerjee, Debasish, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
Background

High cardiovascular risk patients on the kidney transplant list often undergo cardiac interventions to improve their outcome and survival following transplantation. However the benefits of these interventions are currently unknown and were explored in this study.

Methods

The study, approved by hospital Clinical Effectiveness and Audits Committee, included 164 episodes in 126 patients discussed in discussed in a multidisciplinary cardio-renal MDT, between 1-10-2014 to 30-09-2017 and followed until 23-05-2018.

Results

126 patients were discussed in the multidisciplinary meeting, some more one than once. Clinical characteristics of the 164 patient episodes were; age 61±8years, BMI 28±5kg/m2, cholesterol 4.0±1.1mmol/L, 61% diabetes, 96% hypertension, 63% haemodialysis and 27% pre-dialysis. After discussion 96 cardiac procedures were suggested and performed, including stress echocardiogram (68%), echocardiogram (9%), coronary angiogram (13%), percutaneous coronary intervention (4%), and coronary artery bypass graft (4%). The non-invasive tests resulted in further 19 angiograms, 10 PCI and 1 CABG. Thirty-five percent of patients had no cardiac intervention performed; 44% had a single intervention and 21% had multiple interventions.
28 patients had an event (death, ACS or stroke) during follow-up, who were more likely to be diabetic, the clinical characteristics are in table 1.
37% (n= 13) of patients who had invasive cardiac intervention developed an event, while 16% (n=7) of patients who did not receive any cardiac tests or intervention developed an event (p=0.246). Of the 91 patients who did not have invasive procedures, only 15 (16%) had an event as opposed to 13 (37%) in the remaining cohort who had invasive procedures done (Figure 1).

Conclusion

Out of 126, events occurred in 28 patients, mainly cardiovascular. Cardiac interventions including angiograms, CI or CABG were unable to lower the CV event rate in high-risk patients on transplant waitlist. .