Kidney Week

Abstract: FR-PO1126

Cardiovascular Evaluation in Kidney Transplant Candidates on the Waiting List

Session Information

• Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Paulmann, Anastasia, Medizinische Hochschule Hannover, Hanover, NDS, Germany

Anastasia Paulmann, MD

• Scheffner, Irina, Medizinische Hochschule Hannover, Hanover, NDS, Germany

Irina Scheffner, MS

• Schmidt-Ott, Kai M., Medizinische Hochschule Hannover, Hanover, NDS, Germany

Kai M. Schmidt-Ott, MD, FASN

• Gwinner, Wilfried, Medizinische Hochschule Hannover, Hanover, NDS, Germany

Wilfried Gwinner, MD

Background

Kidney transplantation is the treatment of choice for end-stage kidney disease; however, cardiovascular disease remains a leading cause of post-transplant morbidity and mortality. Despite cardiovascular screening prior to transplantation, predictive value for early post-transplant cardiovascular events remains incompletely understood. Patients with known coronary artery disease (CAD) represent a high-risk population with substantial cardiovascular event burden, yet it remains unclear whether routine pre-transplant assessments can reliably identify those at highest risk. This study aimed to evaluate if pre-transplant cardiovascular screening can predict early post-transplant cardiovascular events.

Methods

We retrospectively analyzed a cohort of 1,753 kidney transplant recipients. Patients were classified by CAD status and by occurrence of major cardiovascular events within the first post-transplant year. All patients underwent cardiovascular assessment prior to transplantation, including non-invasive and, where clinically indicated, invasive cardiac evaluation. Clinical characteristics, cardiovascular risk profiles and pre-transplant non-invasive cardiac parameters were systematically evaluated, including left ventricular ejection fraction, wall motion abnormalities, exercise capacity, maximum heart rate, deviation from target heart rate, and time intervals from last cardiac investigation to transplantation.

Results

CAD was identified in 15,3% of patients pre-transplant. Among these, 7.1% experienced a cardiovascular event within the first post-transplant year. Notably, cardiovascular events also occurred in 1,3% of patients without previously known CAD, indicating a diagnostic gap in current screening pathways. Non-invasive cardiac assessment showed limited ability to predict post-transplant cardiovascular events. While the performance of pre-transplant coronary angiography was associated with a lower event rate, coronary intervention itself was not, suggesting that invasive testing strategies may primarily reflect selection of high-risk patients rather than modifying outcome risk.

Conclusion

Non-invasive cardiovascular screening shows limited utility in predicting post-transplant cardiovascular events. Our findings support a critical re-evaluation of pre-transplant screening protocols in kidney transplant candidates, with particular attention to the role and timing of invasive assessment.