T SALEHI1, N MONTARELLO2, A BATE2, P CLAYTON1, M WORTHLEY2, P COATES1
1Central Adelaide And Northern Renal And Transplantation Services, Adelaide, Australia, 2Department of Cardiology, Adelaide, Australia
Background: Cardiovascular events remain a major cause of death in kidney transplant recipients. The optimal non-invasive test modality to prevent peri-operative cardiac mortality in renal transplant remains contentious.
Methods: We conducted a retrospective analysis to assess the renal transplantation cardiovascular assessment protocol within a single-centre population over a 5-year period. Asymptomatic patients under 45 years, with no history of cigarette smoking, without diabetes mellitus, and dialysis-dependent for less than 24 months, did not undergo cardiac testing prior to listing as per our current protocol. All other asymptomatic patients required a non-invasive, tachycardic-induced stress test, where a target heart rate of 85% predicted for age and gender was required. The primary endpoints were rates of acute myocardial infarction (AMI) and cardiovascular death at 30 days post renal transplantation.
Results: Between January 2015 and December 2019, a total of 380 recipients underwent cardiac evaluation: 79 (20.8%) were deemed low risk and placed on the renal transplant waitlist without further assessment; 270 (71.1%) underwent a tachycardic-induced stress test; and 31 (8.1%) were deemed high risk and proceeded directly to invasive coronary angiography (ICA). In the five-year follow-up, three patients (0.8%) experienced an AMI at 30 days post renal transplantation, all of which occurred in the high risk ‘direct to ICA’ cohort. None occurred in the low risk ‘no stress test required’ or ‘tachycardic-induced stress test’ cohorts. There were no cardiovascular deaths at 30 days post transplantation.
Conclusion: A negative tachycardic-induced cardiac stress test, achieving 85% predicted heart rate, was associated with a 0% AMI rate and no cardiovascular deaths at 30 days post renal transplantation.
Nephrology advanced trainee