Abstract: FR-PO1125
Association of Pretransplant Cardiac Testing with Early Cardiac Events
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
- Sawinski, Deirdre L., Weill Cornell Medicine, New York, New York, United States
- Simmons, Will, Weill Cornell Medicine, New York, New York, United States
- Tummalapalli, Sri Lekha, Weill Cornell Medicine, New York, New York, United States
Background
The ESKD population is at increased risk for cardiac mortality. Pretransplant testing algorithms seek to minimize early posttransplant cardiac complications. The association between pretransplant cardiac testing and 90 day post transplant cardiac events is understudied.
Methods
We performed a retrospective cohort study of all kidney transplants performed at our institution from 1/1/2010 through 4/30/2025 with follow up through 7/30/2025. We extracted cardiac echo, nuclear stress test and cardiac catheterization test results for exams performed as part of the pretransplant evaluation; these formed the exposures of interest. Echo data were characterized by ejection fraction (hyperdynamic, normal, reduced); stress test data by the presence of ischemia (abnormal myocardial perfusion or ischemic ST segment changes) and cath data noted if stenting was performed. The outcomes of interest were incident heart failure (HF), MI or death within 90 days of transplantation. Models were adjusted for age, sex, race, diabetes, hypertension, hyperlipidemia, peripheral vascular disease, smoking and dialysis time. This study was approved by our local IRB.
Results
A total of 3355 patients were included; 62% were male. Patients were 39% White, 25% Black, 14% Latino and 14% Asian. Fifty percent had a diagnosis of diabetes, 66% had hypertension and 71% had hyperlipidemia. Only 12% were current smokers and 35% had PVD. The median age at transplant was 57 yrs (45-66), 37% were pre-emptive and 51% received a living donor. The most frequent cardiac event was incident heart failure (n=315, 9.4%), followed by incident myocardial infarct (n=71, 2.1%); death was rare (n=29, 0.9%). Reduced EF was associated with an increased relative risk for HF hospitalization (aRR 4.63, 95% CI 3.8-5.56) and ischemic events (aRR 1.78, 95% CI 1.32-2.38). Catheterization with stenting was associated with an increased risk of 90 day ischemic events (aRR 4.5, 95% CI 2.7-7.71). Ischemia on stress testing was associated with HF admission (aRR 2.16, 95% CI 1.75-2.66) and ischemic events (aRR 1.70, 95% CI 1.16-2.49).
Conclusion
Early posttransplant mortality was rare. Pretransplant cardiac testing demonstrated a strong association between reduced EF and HF events; reduced EF on echo, ischemia on stress test and prior stenting were associated with ischemic complications. Further study is needed to determine the optimal pretransplant cardiac evaluation practices.