Pre-transplant cardiac testing for kidney-pancreas transplant candidates and association with cardiac outcomes

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Background:Coronary artery disease is a major cause of mortality following renal transplantation, especially in those patients with diabetes. The accurate prediction of cardiac risk is therefore a major focus of the pre-transplant evaluation. The objective of this study was to retrospectively evaluate the ability of non-invasive cardiac testing (standard echocardiography, stress echocardiography, exercise tolerance testing, and nuclear myocardial perfusion) performed within 1 yr of kidney-pancreas transplant to predict post-transplant myocardial infarction.Methods:Clinical history and pre-transplant cardiac testing performed within 1 yr prior to transplantation were reviewed in a non-blinded fashion for 165 kidney-pancreas transplantation patients receiving allografts between June 1990 and May 1998. The predictive values of clinical symptoms and cardiac testing for cardiac events (fatal and non-fatal myocardial infarctions) up to 1 yr post-transplant were calculated.Results:Clinical history had a negative predictive value of 98% for cardiac events occurring within 1 yr following testing and 97% within 1 yr post-transplant. Collectively, non-invasive testing had a negative predictive value of 97% for 1 yr post-testing and 1 yr post-transplant.Conclusion:Clinical history alone is highly suggestive but not sufficient for the prediction of post-kidney-pancreas transplant myocardial infarction. Although a useful supplement, cardiac testing does not predict all cardiac events out to 1 yr post-testing. In this high-risk patient population with diabetes and renal failure, other methods of risk assessment are needed to more accurately predict long-term cardiac outcome for patients awaiting transplantation.

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