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

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Abstract
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.