Stress myocardial perfusion imaging vs. stress echocardiography for risk stratification of kidney transplant candidates: Does it even matter?

Excerpt

Cardiovascular disease (CVD), rather than end-stage kidney disease (ESRD), is the leading cause of death in patients with chronic kidney disease (CKD), accounting for nearly 50% of all deaths.^1,2 In the USA, there are over 100,000 patients awaiting kidney transplant and close to 3000 patients are added to the waiting list every month.³ With such a high prevalence of CVD in CKD patients and limited number of donor kidneys, several professional societies provide recommendations for cardiac assessment of patients undergoing kidney transplantation in an effort to optimize peri-transplant outcomes. While management of patients with symptomatic coronary artery disease (CAD) is generally well defined, the management and outcome implications of pre-operative cardiac testing in asymptomatic ESRD patients are unclear. The 2014 ACC/AHA peri-operative cardiovascular evaluation guidelines for non-cardiac surgery are not intended for patients undergoing solid organ transplant evaluation.⁴ ESRD patients have a significantly higher prevalence of CAD (up to 53%) in comparison to non-ESRD patients.⁵ Additionally, cardiac risk assessment of kidney transplant candidates extends beyond the peri-operative period and demands long-term cardiac risk stratification to ensure proper organ allocation to a host with a favorable long-term prognosis. …