Kidney Week

Abstract: SU-OR47

Does Screening for Coronary Artery Disease Predict Cardiac Outcomes Following Renal Transplantation?

Session Information

• Challenges in Clinical Transplantation
  October 25, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Nimmo, Ailish, Southmead Hospital, Bristol, Bristol, United Kingdom

Ailish Nimmo, MBChB



I am a renal registrar currently working as a clinical research fellow in Bristol, UK. I am interested in renal epidemiology and my current research is focusing on the utility of routinely collected healthcare data in people with kidney disease and cardiovascular outcomes in people with a kidney transplant.

• Taylor, Dominic M., Southmead Hospital, Bristol, Bristol, United Kingdom

Dominic M. Taylor,

• Ravanan, Rommel, Southmead Hospital, Bristol, Bristol, United Kingdom

Rommel Ravanan,

Background

Screening for asymptomatic coronary artery disease (CAD) prior to transplantation aims to reduce perioperative cardiac events. There is conflicting evidence as to whether this is achieved.

Methods

Individuals recruited to the Access to Transplant and Transplant Outcome Measures (ATTOM) study in England who received a renal transplant between 2011-2017 were studied. Patient demographics and details of screening investigations from ATTOM were linked to outcome data from the Hospital Episode Statistics dataset.

Major Adverse Cardiac Events (MACE) comprised unstable angina, myocardial infarction, coronary bypass graft, coronary angioplasty or cardiac death. The effect of screening on MACE was analysed in propensity score-matched groups, using Cox survival analyses, up to 5 years post-transplant.

Results

2572 individuals received a renal transplant; 51% underwent CAD screening (Figure 1). Age, ethnicity, ischaemic heart disease and diabetes were independently associated with screening. The incidence of MACE at 90 days, 1 and 5 years was 0.9%, 2.1% and 9.4%.

After propensity score matching, 1854 individuals were examined. There was no association between screening and MACE at 90 days (HR 0.68, 95% CI 0.28-1.64), 1 year (HR 1.24, 95% CI 0.60–2.54) or 5 years (HR 1.31, 95% CI 0.95–1.79) (Figure 2).

Conclusion

Screening for CAD did not influence the rate of ischaemic cardiac events up to 5 years post-transplant. Units should review protocols with lengthy cardiac workup processes.

Workup patterns. Stress tests: exercise tolerance test, stress echo or myocardial perfusion scan.

Factors associated with MACE following propensity score matching