Abstract: TH-PO1136
Managing High Cardiovascular Risk Patients on Kidney Transplant Waiting List: Costs and Outcome
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Junarta, Joey, St George's, University of London, London, United Kingdom
- Chung, Isaac Wen Yao, St George's, University of London, London, United Kingdom
- Banerjee, Debasish, St George's Hospital, London, United Kingdom
Background
High cardiovascular risk patients on the kidney transplant waiting list undergo multiple cardiovascular investigations to ensure fitness for transplant surgery, yet suffering from adverse events. The ideal protocol for managing these patients is unknown. We investigated the benefits of cardiorenal multidisciplinary meetings in managing these patients.
Methods
We analysed data from 126 patients discussed between September 1/10/14 and 30/9/17 in biannual multidisciplinary team (MDT) meetings as per protocol, followed up until 11/05/19. We analysed the results of post-MDT cardiac testing and outcomes, including CV events, mortality, and transplantation status. The cost of post MDT cardiac testing was estimated from NHS best practice tariffs.
Results
Clinical characteristics of 126 patients were: age (median 62 years, Inter-quartile range [IQR] 57-67), sex (male 60%), Diabetes Mellitus (58%), Smoker (41%), Hypertension (96%), cholesterol (median 3.8 mmol/L, IQR 3.1-4.8), and PTH (median 33 ng/L, IQR 16-67). The patients were followed-up for a median of 970 days (IQR 584-1334). During the follow up, 44 patients were transplanted.
42 patients had adverse outcomes: 13 patients died , 14 suffered ACS, 5 suffered stroke, 1 suffered TIA, 15 underwent PCI, 7 underwent CABG. Diabetic patients were more likely suffer from adverse events (log-rank test p=0.007). Patients with positive stress echocardiogram tended to have more events, but the difference was not statistically significant (log-rank test p = 0.085). There was no difference comparing the group with or without events with respect to age, gender, smoking, hypertension, cholesterol, PTH, phosphate or ferritin levels.
The costs of post MDT cardiac tests were as follows: 62 stress echo = £1500, 32 Coronary Angiograms = £88632, 13 PCIs = £52325, and 5 CABG = £38350, and total cost = £193897. The approximate cost per patient is £1538, which is approximately £600 per patient per year.
Conclusion
The biannual cardiorenal MDT maintained 126 high risk patients on the kidney transplant waitlist for 2.7 years with successful transplants in 35%, adverse events in 33%, and mortality in 13%. A cardio-renal MDT approach for high CV risk patients can ensure successful transplantation one-third patients in 2.7 years with acceptable cost of cardiac testing despite adverse outcomes.