*Purpose: Cardiovascular disease is an important cause of death after kidney transplantation (KT). It is unclear whether screening asymptomatic patients for coronary artery disease (CAD) prior to KT is associated with improved post-transplant cardiovascular outcomes.
*Methods: We conducted a retrospective multicenter cohort study of KT candidates who were at high risk for cardiovascular disease and underwent pre-transplant non-invasive and/or invasive CAD evaluation between 2016-2019. High-risk patients were defined as those with diabetes mellitus, CAD, left ventricular ejection fraction (LVEF)<50%, ventricular arrhythmias or patients aged ≥50 years with a history of at least one of the following: hypertension, hyperlipidemia, smoking, ≥ 1 year of dialysis. The primary composite endpoint (CE) included death, non-fatal MI, coronary revascularization, non-fatal stroke, and new onset arrhythmias.
*Results: 226 KT recipients were included in the study. 124 underwent cardiac catheterization prior to KT, of which 30 (24%) had severe CAD.102 patients underwent non-invasive CAD evaluation. The five-year Kaplan-Meier estimate for the incidence of post-transplant cardiovascular events was 23%. Multivariable logistic regression showed that a prior history of CAD (OR: 8.64, 95% CI: 3.29-25.51) and LVEF <50% (OR: 5.31, 95% CI: 1.60-18.29) were independently associated with higher odds of finding severe CAD on pre-transplant coronary angiography after adjusting for diabetes mellitus status, age, and time on dialysis (Figure 1A). While cardiac catheterization was associated with a higher risk of CV events post-transplant, stratified analysis by pre-transplant CAD status showed no association between cardiac catheterization and post-transplant CV outcomes (Figure 1B-D). The finding of severe CAD (stenosis ≥70% in ≥1 vessel or three-vessel disease) on coronary angiography was the only factor associated with higher odds of developing the CE within six months of KT (OR: 7.08, 95% CI: 1.31-53.10, Figure 1E). However, in those with severe CAD, revascularization was not associated with lower odds of developing the CE within six months of transplantation (OR: 1.88, 95% CI: 0.21-40.84).
*Conclusions: Pre-transplant coronary angiography provides prognostic information but is not clearly associated with a lower risk of post-transplant cardiovascular events in kidney transplant candidates.

Leela Morena

Massachusetts General Hospital- Harvard Medical School

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