Kidney Week

Abstract: FR-PO1146

Cardiac Risk Stratification for Kidney Transplant Candidacy: A Survey of US Transplant Programs

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

• Gupta, Mallika, The University of Kansas Medical Center, Kansas City, Kansas, United States

Mallika Gupta, MD, FASN

• Mansuri, Rushda Faruk, Saint Louis University, St. Louis, Missouri, United States

Rushda Faruk Mansuri, MBBS, MPH

• Bhave, Nicole M., University of Michigan, Ann Arbor, Michigan, United States

Nicole M. Bhave, MD

• Bobba, Sindhura, Richmond VA Medical Center, Richmond, Virginia, United States

Sindhura Bobba, MD

• Cheng, Xingxing S., Stanford University, Stanford, California, United States

Xingxing S. Cheng, MD, MS

• Gupta, Gaurav, Virginia Commonwealth University, Richmond, Virginia, United States

Gaurav Gupta, MD

• Khirfan, Diala Tareq, Tulane University, New Orleans, Louisiana, United States

Diala Tareq Khirfan, MD

• Kumar, Dhiren, Virginia Commonwealth University, Richmond, Virginia, United States

Dhiren Kumar, MD

• Kumar, Vineeta, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Vineeta Kumar, MD, FASN

• Levea, Swee-Ling, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Swee-Ling Levea, MD

• Malhotra, Divyanshu, Johns Hopkins Medicine, Baltimore, Maryland, United States

Divyanshu Malhotra, MBBS

• Sharma, Akhil, University of Michigan, Ann Arbor, Michigan, United States

Akhil Sharma, DO

• Shroff, Gautam R., Hennepin Healthcare System Inc, Minneapolis, Minnesota, United States

Gautam R. Shroff, MBBS

• Singh, Neeraj, Rutgers University New Brunswick, New Brunswick, New Jersey, United States

Neeraj Singh, MD

• Singh, Priyamvada, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Priyamvada Singh, MD, FASN

• Shrivastava, Pritika, Henry Ford Health System, Detroit, Michigan, United States

Pritika Shrivastava, MD

• Yadav, Anju, Johns Hopkins Medicine, Baltimore, Maryland, United States

Anju Yadav, MD, FASN

• Yerram, Preethi, University of Missouri System, Columbia, Missouri, United States

Preethi Yerram, MD, MS, FASN

• Benjamin, Mina M., Saint Louis University, St. Louis, Missouri, United States

Mina M. Benjamin, MD, MSc

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine, MD, PhD, FASN

Background

Cardiovascular disease is increasingly prevalent in the aging CKD population and remains a major consideration in kidney transplant (KT) candidacy. We conducted a national survey of U.S. KT programs to evaluate pre-KT cardiac risk stratification practices.

Methods

A multidisciplinary workgroup developed an electronic survey distributed to U.S. adult KT programs via the REDCap platform. Questions were organized by cardiac phenotype to assess clinical decision-making across cardiovascular screening domains, including ischemia testing and pulmonary hypertension.

Results

Responses from 62 unique centers were collected between Nov 2025 to February 2026. Known CAD (98%) and diabetes (95%) were the leading drivers of ischemia testing decisions, followed by dialysis vintage, cardiac symptoms, and older age (Fig. A). Most centers used structured cardiology-based evaluation for high-risk candidates, with myocardial perfusion imaging as the preferred initial non-invasive test and cardiology referral for abnormal findings. Severe aortic stenosis, elevated PASP (>45 mmHg), and reduced LVEF commonly influenced candidacy decisions. Following cardiovascular interventions, most centers reported relisting within 1 yr. Waitlist surveillance practices varied, with most centers repeating echocardiography and CAD screening every 1–2 yrs. Delisting after cardiac testing was reported by 45% of centers, while 27% of centers reported bleeding as a testing complication (Fig. B). Multidisciplinary care and improved medical management were the most commonly proposed strategies for improving post-KT outcomes. outcomes.

Conclusion

The survey identified marked variation in pre-KT cardiac evaluation practices, suggesting persistent uncertainty regarding optimal approaches to cardiac risk assessment and management and a need for implementation research in this population.

Acknowledgment

On behalf of the KPCOP Cardiovascular Workgroup