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Junk E, Tzivian L, Folkmane I, Folkmanis K, Jushinskis J, Strazda G, Folkmanis V, Kuzema V, Petersons A. Major adverse cardiovascular events and hyperuricemia as an effect-modifying factor in kidney transplant recipients. World J Transplant 2025; 15:102287. [DOI: 10.5500/wjt.v15.i3.102287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 01/31/2025] [Accepted: 02/20/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Major adverse cardiovascular (CV) events (MACEs) are the primary cause of morbidity and mortality in kidney transplantation (KT) recipients. The risk for MACEs is impacted by an array of traditional and transplant-related non-traditional CV risk factors.
AIM To investigate the association between potential CV risk factors related to KT and MACEs, and their potential modification by hyperuricemia (HU).
METHODS The relationship between CV risk factors related to KT and MACEs was examined in a cohort of 545 patients who underwent transplantation between 2008 and 2019. The mean age of patients at KT was 55.0 years ± 14.2 years (range 15.0–89.0 years). Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACEs. To explore the potential effect modification by uric acid (UA), patients were categorized into groups based on UA levels: (1) Low (< 356 μmol/L); (2) Normal (356–416 μmol/L); (3) High (416–475 μmol/L); and (4) Very high (> 475 μmol/L).
RESULTS MACEs occurred in 145 of 545 (26.6%) KT recipients. The most prevalent comorbidities were hypertension (87%), dyslipidemia (78%), secondary hyperparathyroidism (68%), HU (63%) and anemia (33%). In the multivariate logistic regression model, the most significant factors associated with MACEs were previous CV events [odds ratio (OR) = 70.6, 95%CI: 24.9–200.1], left ventricular hypertrophy (LVH) (OR = 12.6, 95%CI: 2.7– 58.3), HU treatment (OR = 4.3, 95%CI: 2.4–7.6), and anemia (OR = 5.3, 95%CI: 2.9–9.8). Effect modification by the presence of HU revealed that independent factors associated with MACEs were age (OR = 1.03, 95%CI: 1.0–1.1), previous CV events (OR = 41.7, 95%CI: 13.6–127.6), LVH (OR = 15.3, 95%CI: 2.0–116.6), HU treatment (OR = 2.5, 95%CI: 1.3–4.6) and anemia (OR = 5.4, 95%CI: 2.8–10.5). Effect modification by UA levels dichotomized at 475 μmol/L (very high level of UA) revealed that HU treatment was not associated with MACEs in groups with or without very high UA levels.
CONCLUSION A very high level of UA was observed to act as an effect-modifying factor for MACEs, especially when combined with other risk factors such as age, previous CV events, LVH, and anemia.
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Affiliation(s)
- Elizabete Junk
- Department of Internal Diseases, St. Bonifatius Hospital Lingen, Lingen 49808, Germany
- Faculty of Medicine and Life Sciences, University of Latvia, Riga LV-1004, Latvia
| | - Lilian Tzivian
- Faculty of Medicine and Life Sciences, University of Latvia, Riga LV-1004, Latvia
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University of Dusseldorf, Düsseldorf 40225, Germany
| | - Inese Folkmane
- Faculty of Medicine and Life Sciences, University of Latvia, Riga LV-1004, Latvia
- Centre of Nephrology, Pauls Stradiņš Clinical University Hospital, Riga LV-1002, Latvia
| | - Kristofs Folkmanis
- Faculty of Medicine and Life Sciences, University of Latvia, Riga LV-1004, Latvia
- International Center for Robotic Urology, Kreisklinikum Siegen, Siegen 57076, North Rhine-Westphalia, Germany
| | - Janis Jushinskis
- Centre of Transplantation, Pauls Stradiņš Clinical University Hospital, Riga LV-1002, Latvia
- Faculty of Medicine, Riga Stradins University, Riga LV-1007, Latvia
| | - Gunta Strazda
- Faculty of Medicine and Life Sciences, University of Latvia, Riga LV-1004, Latvia
| | - Valdis Folkmanis
- Faculty of Medicine and Life Sciences, University of Latvia, Riga LV-1004, Latvia
| | - Viktorija Kuzema
- Centre of Nephrology, Pauls Stradiņš Clinical University Hospital, Riga LV-1002, Latvia
- Faculty of Medicine, Riga Stradins University, Riga LV-1007, Latvia
| | - Aivars Petersons
- Faculty of Medicine, Riga Stradins University, Riga LV-1007, Latvia
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2
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Biolato M, Miele L, Avolio AW, Marrone G, Liguori A, Galati F, Petti A, Tomasello L, Pedicino D, Lombardo A, D'Aiello A, Pompili M, Agnes S, Gasbarrini A, Grieco A. Diagnostic accuracy and cost-effectiveness of the CAR-OLT score in predicting cardiac risk for liver transplantation. World J Transplant 2025; 15. [DOI: 10.5500/wjt.v15.i2.99208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 12/13/2024] [Accepted: 01/14/2025] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND
The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant (LT).
AIM
To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.
METHODS
This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome, Italy. Cardiac contraindications for LT listing were defined after a center-specific cardiac workup, which included cardiac stress tests for most patients. The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic (AUROC) method.
RESULTS
A total of 342 LT candidates were evaluated between 2015 and 2019, with a moderate cardiovascular risk profile (37% diabetes, 34% hypertension, 22% obesity). Of these, 80 (23%) candidates underwent coronary angiography. Twenty-one (6%) candidates were given cardiac contraindications to LT listing, 48% of which were due to coronary artery disease. The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81. The optimal cut-off for sensitivity was a CAR-OLT score ≤ 23, which showed a 99% negative predictive value for cardiac contraindications to LT listing. A total of 84 (25%) LT candidates with a CAR-OLT score ≤ 23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing, with estimated costs of approximately 48000€. The estimated savings per patient was €574.70 for the Italian National Health System.
CONCLUSION
A CAR-OLT score ≤ 23 can identify LT candidates who can be safely listed without the need for cardiac stress tests, providing time and cost savings. These findings require external validation.
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Affiliation(s)
- Marco Biolato
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Luca Miele
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Alfonso W Avolio
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Giuseppe Marrone
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Antonio Liguori
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Francesco Galati
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Anna Petti
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Lidia Tomasello
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Daniela Pedicino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Alessia D'Aiello
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Maurizio Pompili
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Salvatore Agnes
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
| | - Antonio Grieco
- Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
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3
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Shroff GR, Benjamin MM, Rangaswami J, Lentine KL. Risk and management of cardiac disease in kidney and liver transplant recipients. Heart 2025:heartjnl-2024-324796. [PMID: 40306758 DOI: 10.1136/heartjnl-2024-324796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 03/31/2025] [Indexed: 05/02/2025] Open
Abstract
Organ transplantation is the treatment of choice for individuals with kidney failure requiring kidney replacement therapy, as well as for those with end-stage liver disease. Despite the significant reduction in long-term morbidity and mortality with transplantation, kidney and liver allograft recipients remain at high risk for cardiovascular disease (CVD) and premature death from cardiovascular causes. This heightened risk is represented across all phenotypes of CVD, including coronary heart disease, heart failure, arrhythmias, valvulopathies and pulmonary hypertension. Pre-existing vascular risk factors for CVD, coupled with superimposed cardiovascular-kidney-metabolic derangements after transplantation, driven at least in part by post-transplant weight gain, immunosuppressive therapies and de novo risk factors such as dyslipidaemia and diabetes, coalesce to increase total CVD risk. In this review, we summarise pathophysiological considerations for both the short- and long-term increase in CVD risk following kidney/liver transplantation. We review the different phenotypes of CVD, with unique considerations for post-transplant care in this patient population. Finally, we highlight the need for awareness about long-term CVD risk and a multidisciplinary approach to managing organ-specific CVD risk in kidney and liver transplant patients.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mina M Benjamin
- Division of Cardiology, Department of Internal Medicine, SSM Health Saint Louis University Hospital, St Louis, Missouri, USA
| | - Janani Rangaswami
- Internal Medicine, The George Washington University Hospital, Washington, DC, USA
| | - Krista L Lentine
- Saint Louis University Transplant Center, SSM Health Saint Louis University Hospital, St Louis, Missouri, USA
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4
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Devauchelle P, Bignon A, Breteau I, Defaye M, Degravi L, Despres C, Godon A, Guérin R, Lavayssiere L, Lebas B, Maurice A, Monet C, Monsel A, Reydellet L, Roullet S, Rozier R, Guichon C, Weiss E. Perioperative Management During Liver Transplantation: A National Survey From the French Special Interest Group in "Liver Anesthesiology and Intensive Care". Transplantation 2025; 109:671-680. [PMID: 40071909 DOI: 10.1097/tp.0000000000005264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2025]
Abstract
BACKGROUND Perioperative management practices in liver transplantation (LT) evolve very quickly. There are few specific recommendations, often based on a low level of evidence, resulting in wide heterogeneity of practices. METHODS We performed a survey in all 16 French centers in 2021 by focusing on center organization, preoperative cardiovascular assessment, antimicrobial prophylaxis, hemostasis management, intraoperative use of hemodynamic monitoring and renal replacement therapy, immunosuppression, and postoperative prevention of arterial complications and compared it with current recommendations. RESULTS The organization of perioperative LT care involved 1 single team throughout the perioperative LT process in 7 centers (43.7%). The coronary evaluation was systematic in one-third of the centers and guided by risk factors in the other centers. Antibiotic prophylaxis was strictly intraoperative in only 7 centers (44%). Antifungal prophylaxis targeting high-risk LT recipients was administered in 15 centers (93%). Intraoperative coagulation assessment was based on standard coagulation tests in 8 centers (50%), on viscoelastic assays in 4 centers (25%), and both methods in 4 centers (25%). Hemodynamic monitoring practices greatly varied between centers.Concerning immunosuppression, molecules and dosages were heterogeneous. Aspirin was systematically administered in one-third of cases (6 centers; 37.5%). Of the 21 recommendations tested, the concordance rate was 100% for 3 recommendations and <50% for 7 recommendations. CONCLUSIONS Our study precisely describes French practices regarding LT in perioperative care and highlights the paucity of data in this setting, leading to very weak recommendations that are poorly followed in LT centers.
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Affiliation(s)
- Pauline Devauchelle
- Department of Anaesthesiology and Critical Care, Hôpital Beaujon, AP-HP, Clichy, France
| | - Anne Bignon
- CHU Lille, Surgical Critical Care and Hepatic Transplant Unit, Department of Anesthesia Critical Care and Perioperative Medicine, Lille, France
| | - Isaure Breteau
- Department of Anesthesia and Surgical Intensive Care Unit, Tours University Hospital, Tours, France
| | - Mylène Defaye
- Department of Anaesthesia and Intensive Care, Bordeaux University Hospital, Pessac, France
| | - Laurianne Degravi
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, France
| | - Cyrielle Despres
- Department of Anaesthesia and Intensive Care, Minjoz Hospital, Besançon University Hospital, Besançon, France
| | - Alexandre Godon
- Department of Anaesthesia and Intensive Care, University of Grenoble Alpes, Grenoble Alpes University Hospital, Grenoble, France
| | - Renaud Guérin
- Service De Réanimation Adultes, Unité de Soins Continus et Unité de Transplantation Hépatique, pôle MPO, CHU Estaing, Clermont-Ferrand, France
| | - Laurence Lavayssiere
- Intensive Care Unit, Department of Transplantation, Rangueil University Hospital, Toulouse, France
| | - Benjamin Lebas
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Axelle Maurice
- Département d'Anesthésie réanimation chirurgicale, CHU Pontchaillou, Rennes, France
| | - Clément Monet
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, France
| | - Antoine Monsel
- Sorbonne Université-INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy, Paris, France
- Biotherapy (CIC-BTi), La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Paris, France
- UMRS-938, Research Center of Saint-Antoine (CRSA), Sorbonne University, Paris, France
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Laurent Reydellet
- Service d'Anesthésie-Réanimation, Réanimation Polyvalente et Pathologie du Foie, APHM, C.H.U. Timone, Marseille, France
| | - Stéphanie Roullet
- Département d'Anesthésie Réanimation, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
- Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITH U1176, Le Kremlin-Bicêtre, France
| | - Romain Rozier
- Department of Anesthesia and Intensive Care, University of Cöte d'Azur, University Hospital Archer 2, Nice, France
| | - Céline Guichon
- Service d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Université de Paris, Hôpital Beaujon, AP-HP, Clichy, France
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5
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Bahl A, Prasad N, Sinha DP, Ganguly K, Roy S, Roy D, Rakshit S, Kumar D, Das S, Bhasin D, Raju SB, Trivedi M, Rathi M, Gulati S, Agstam S, Bhargava V, Bhalla AK, Bansal SB, Varughese S, Patel MR, Yadav R, Naik N, Bang VH, Dastidar DG, Banerjee PS. Cardiac evaluation in patients awaiting kidney transplant-position statement of the Cardiological Society of India and Indian Society of Nephrology. Indian Heart J 2025:S0019-4832(25)00058-6. [PMID: 40147817 DOI: 10.1016/j.ihj.2025.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/25/2024] [Accepted: 03/25/2025] [Indexed: 03/29/2025] Open
Abstract
Cardiovascular diseases are a major cause of death after kidney transplantation. This statement addresses preoperative cardiac decision-making and management with the aim of assessing and reducing the risk of the kidney transplant surgery. Important issues from a clinician's perspective include the basic cardiovascular workup of these patients, coronary evaluation and management of coronary artery disease, valvular heart disease and left ventricular systolic dysfunction. Recovery left ventricular function after kidney transplant is discussed. In addition, the use of cardiovascular drugs in patients with special emphasis on antiplatelets and anticoagulants in patients planned for kidney transplant is also discussed.
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Affiliation(s)
- Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | | | - Debabrata Roy
- Department of Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Sumit Rakshit
- Department of Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Dilip Kumar
- Medica Superspeciality Hospital, Kolkata, India
| | - Saurav Das
- Medica Superspeciality Hospital, Kolkata, India
| | - Dinkar Bhasin
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sree Bhushan Raju
- Dept of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Mayuri Trivedi
- Department of Nephrology, Lokmanya Tilak Municipal General Hospital, Mumbai, India
| | - Manish Rathi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Gulati
- Principal Director, Nephrology and Transplantation, Fortis Group Hospitals, New Delhi, India
| | - Sourabh Agstam
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinant Bhargava
- Department of Nephrology, Sir Gangaram Hospital, New Delhi, India
| | | | | | | | - Manas Ranjan Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Yadav
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Partha Sarathi Banerjee
- Chief Interventional Cardiologist, Manipal Hospital, Kolkata, Former Head, Department of Cardiology, Medical College, Kolkata, India
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6
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García-Cosío MD, Cruzado JM, Farrero M, Blasco Peiró MT, Crespo M, Delgado Jiménez JF, Díaz Molina B, Fernández Rivera C, Garrido Bravo IP, López Jiménez V, Melilli E, Mirabet Pérez S, Pérez Tamajón ML, Rangel Sousa D, Rodrigo Calabia E, Hernández Marrero D. Management of heart disease in renal transplant recipients: a national Delphi survey-based SET/SEC/SEN consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2025; 78:252-262. [PMID: 39442797 DOI: 10.1016/j.rec.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 09/24/2024] [Indexed: 10/25/2024]
Abstract
Renal transplantation improves the survival and quality of life of patients with end-stage renal disease. Cardiovascular disease is the leading cause of morbidity and mortality in renal transplant recipients. The bidirectional relationship between renal and heart disease creates a unique clinical scenario that demands a comprehensive and personalized approach. This expert consensus, drafted by the Spanish Society of Transplantation, the Spanish Society of Cardiology, and the Spanish Society of Nephrology, aims to assess current practices and propose strategies for the management of heart disease in renal transplant recipients. A panel of Spanish nephrologists and cardiologists with expertise in renal and heart transplantation reviewed the scientific evidence concerning the current management of heart disease in renal transplant recipients. Subsequently, consensus statements were created through a 2-round Delphi methodology, resulting in 30 statements covering key topics such as the identification of renal transplant candidates, the management of heart disease in renal transplant recipients, and eligibility for combined heart-kidney transplantation in patients with both end-stage renal disease and cardiac disease. These consensus statements provide expert guidance for the management of heart disease in renal transplant recipients, an area where published clinical evidence remains limited.
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Affiliation(s)
- María Dolores García-Cosío
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Josep María Cruzado
- Servicio de Nefrología, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, Barcelona, Spain
| | - Marta Farrero
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | | | - Marta Crespo
- Servicio de Nefrología, Hospital del Mar, Instituto de Investigaciones Médicas Hospital del Mar, National Network for Kidney Research RICORS2040 RD21/0005/0022, Barcelona, Spain
| | - Juan Francisco Delgado Jiménez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain
| | - Beatriz Díaz Molina
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Iris Paula Garrido Bravo
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Verónica López Jiménez
- Servicio de Nefrología, Hospital Regional Universitario de Málaga, National Network for Kidney Research RICORS2040 RD21/0005/0012, Instituto Biomédico de Investigación de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Edoardo Melilli
- Servicio de Nefrología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Sonia Mirabet Pérez
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Diego Rangel Sousa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Emilio Rodrigo Calabia
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - Domingo Hernández Marrero
- Servicio de Nefrología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, National Network for Kidney Research RICORS2040 RD21/0005/0012, Instituto de Tecnologías Biomédicas, Universidad de La Laguna, Santa Cruz de Tenerife, Spain.
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7
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García-Cosío Carmena MD, Farrero M, Blasco Peiró MT, Crespo M, Delgado Jiménez J, Díaz Molina B, Fernández Rivera C, Garrido Bravo IP, López Jiménez V, Melilli E, Mirabet Pérez S, Pérez Tamajón ML, Rangel Sousa D, Rodrigo E, Cruzado JM, Hernández Marrero D. Management of Kidney Disease in Heart Transplant Patients: A National Delphi Survey-based Consensus Expert Paper. Transplantation 2025:00007890-990000000-01004. [PMID: 39928546 DOI: 10.1097/tp.0000000000005302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2025]
Abstract
Kidney disease is a common complication in heart transplant recipients and requires a comprehensive and personalized approach. The interplay between preexisting kidney disease, perioperative factors, immunosuppression, and cardiovascular complications makes the management of kidney dysfunction challenging in these patients. The objective of this expert consensus was to look for agreements for the management of chronic kidney disease in heart transplant recipients. A panel of Spanish cardiologists and nephrologists with expertise in heart and kidney transplantation reviewed the evidence related to the current management of chronic kidney disease in heart transplant recipients and consensus statements were developed using a 2-round Delphi methodology. Consensus statements were proposed covering key topics, including the identification and management of kidney disease in heart transplant recipients and the indications for kidney transplantation. These statements provide additional expert guidance for the management of kidney disease in patients undergoing heart transplantation where published clinical evidence is scarce.
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Affiliation(s)
| | - Marta Farrero
- Cardiology Department, Hospital Clínic, Barcelona, Spain
| | | | - Marta Crespo
- Nephrology Department, Hospital del Mar, Hospital del Mar Research Institute, National Network for Kidney Research RICORS2040 RD21/0005/0022, Barcelona, Spain
| | - Juan Delgado Jiménez
- Cardiology Department, Hospital Universitario 12 de Octubre, Imas12, CIBERCV, Universidad Complutense de Madrid, Madrid, Spain
| | - Beatriz Díaz Molina
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Iris Paula Garrido Bravo
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Verónica López Jiménez
- Nephrology Department, Hospital Regional Universitario de Málaga, National Network for Kidney Research RICORS2040 RD21/0005/0012, Instituto Biomédico de Investigación de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Edoardo Melilli
- Nephrology Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Sonia Mirabet Pérez
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | | | - Diego Rangel Sousa
- Cardiology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Emilio Rodrigo
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Josep María Cruzado
- Nephrology Department, Hospital Universitario de Bellvitge, Bellvitge Institute for Biomedical Research (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Domingo Hernández Marrero
- Nephrology Department, Hospital Universitario de Canarias, National Network for Kidney Research RICORS2040 RD21/0005/0012; Instituto de Tecnologías Biomédicas, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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8
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Reuter S, Reiermann S, Stypmann J, Bautz J, Schütte‐Nütgen K, Pavenstädt H, Malyar V, Reinecke H, Kurosinski M, Görlich D, Hense H, Suwelack B, Schäfers M. Myocardial Perfusion Scintigraphy Provides Incremental Prognostic Value in Patients on the Kidney Transplant Waiting List. Clin Transplant 2025; 39:e70114. [PMID: 39980435 PMCID: PMC11843186 DOI: 10.1111/ctr.70114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 01/21/2025] [Accepted: 02/07/2025] [Indexed: 02/22/2025]
Abstract
The approach to cardiovascular risk assessment before renal transplantation is still controversial. Therefore, we evaluated and compared the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) who are candidates for kidney transplantation (KTx). METHODS We prospectively enrolled 356 ESRD clinical transplantations for review, only patients (NCT01064674) admitted to our transplant center between August 2009 and July 2012. Cardiovascular risk assessment at the time of listing was based on the Münster Cardiovascular Risk Stratification Score (MCRSS), additionally including evaluation by DSE and MPS in all ESRD patients. Coronary angiography was conducted in patients at high risk according to the MCRSS and in those where noninvasive stress testing revealed stress-induced ischemia or wall motion abnormalities. RESULTS During long-term follow-up until October 2020, 2.43 cardiovascular events/100 person-years (nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) occurred, and the overall patient survival was 71.9%. Mild perfusion deficits identified by MPS, unlike wall motion abnormalities detected by DSE, showed incremental prognostic value for event-free survival in patients with low MCRSS risk. CONCLUSION We therefore propose a modified MCRSS-based approach including MPS as a reasonable risk stratification approach for cardiovascular risk assessment of ESRD patients applying for KTx.
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Affiliation(s)
- Stefan Reuter
- Department of Internal Medicine DUniversity Hospital MünsterMünsterGermany
| | - Stefanie Reiermann
- Department of Internal Medicine DUniversity Hospital MünsterMünsterGermany
| | - Jörg Stypmann
- Department of Cardiology I – Coronary and Peripheral Vascular DiseaseHeart FailureUniversity Hospital MünsterMünsterGermany
| | - Joachim Bautz
- Department of Internal Medicine DUniversity Hospital MünsterMünsterGermany
- Department of Nuclear MedicineUniversity Hospital MünsterMünsterGermany
| | | | - Hermann Pavenstädt
- Department of Internal Medicine DUniversity Hospital MünsterMünsterGermany
- Cells in Motion Interfaculty CentreUniversity of MünsterMünsterGermany
| | - Viola Malyar
- Department of Internal Medicine DUniversity Hospital MünsterMünsterGermany
| | - Holger Reinecke
- Department of Cardiology I – Coronary and Peripheral Vascular DiseaseHeart FailureUniversity Hospital MünsterMünsterGermany
| | | | - Dennis Görlich
- Institute of Biostatistics and Clinical ResearchUniversity of MünsterMünsterGermany
| | - Hans‐Werner Hense
- Institute of Epidemiology and Social MedicineUniversity of MünsterMünsterGermany
| | - Barbara Suwelack
- Department of Internal Medicine DUniversity Hospital MünsterMünsterGermany
| | - Michael Schäfers
- Department of Nuclear MedicineUniversity Hospital MünsterMünsterGermany
- Cells in Motion Interfaculty CentreUniversity of MünsterMünsterGermany
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9
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Ang SP, Chia JE, Iglesias J, Usman MH, Krittanawong C. Coronary Intervention Outcomes in Patients with Liver Cirrhosis. Curr Cardiol Rep 2025; 27:2. [PMID: 39754700 PMCID: PMC11700054 DOI: 10.1007/s11886-024-02163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2024] [Indexed: 01/06/2025]
Abstract
PURPOSE OF REVIEW This review assesses the outcomes of coronary interventions in patients with liver cirrhosis and coronary artery disease (CAD), focusing on the clinical challenges posed by cirrhosis-related hemodynamic and coagulopathic changes. It highlights essential considerations for managing these patients, who have an increased risk of adverse events during coronary procedures. RECENT FINDINGS Recent studies have shown that patients with liver cirrhosis undergoing PCI experience significantly higher mortality rates compared to non-cirrhotic patients, particularly in the context of STEMI and NSTEMI. Coagulopathy and thrombocytopenia increase the risk of bleeding and vascular complications during interventions. Radial access has been suggested as a safer alternative to femoral access in these patients due to reduced bleeding complications. Additionally, contrast-induced nephropathy (CIN) is a prevalent risk, with cirrhotic patients demonstrating higher rates of acute kidney injury post-PCI. Preventive strategies such as minimizing contrast exposure and utilizing intravascular ultrasound (IVUS) are recommended. Managing CAD in cirrhotic patients requires careful consideration of their unique pathophysiological state. Higher in-hospital mortality, bleeding risks, and vascular complications necessitate tailored procedural strategies, such as radial access and contrast minimization. The balance between thrombotic and bleeding risks is critical in decision-making, with IVUS and hydration strategies being promising approaches. Further research is required to optimize treatment protocols and improve long-term outcomes for this high-risk population.
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Affiliation(s)
- Song Peng Ang
- Department of Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA.
| | - Jia Ee Chia
- Department of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Jose Iglesias
- Department of Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA
- Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ, USA
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10
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Bloemendal NT, Prakken NHJ, Gareb B, Benjamens S, Sanders JSF, Slart RHJA, Pol RA. Prognostic value of single photon emission computed tomography myocardial perfusion imaging for the prediction of MACE in pre- kidney transplant recipients: A systematic review and meta-analysis. Transplant Rev (Orlando) 2024; 38:100879. [PMID: 39236547 DOI: 10.1016/j.trre.2024.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Kidney transplantation provides substantial benefits in extending survival and improving quality of life for patients with end-stage renal disease. The incidence of major adverse cardiac events (MACE) increases with a decline of kidney function in patients with chronic kidney disease. After kidney transplantation, the incidence of MACE remains high. The objective of this study was to assess the prognostic significance of pre-transplant single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in kidney transplant recipients. METHODS A systematic literature search was performed between January 1st 2015 and March 26th 2024 in PubMed, EMBASE, Web of Science and The Cochrane Library to identify the prognostic value of SPECT MPI for developing MACE (primary outcome) and mortality (secondary outcome) in kidney transplant recipients (PROSPERO CRD42020188610). Risk of bias was assessed. Meta-analyses and subgroup analyses were performed using random-effects models. RESULTS Six studies comprising 2090 SPECT MPI scans were included. Abnormal SPECT MPI scans were associated with an increased risk of MACE post-transplantation (HR 1.62, 95% CI 1.27-2.06, p < 0.001). Subgroup analyses showed consistent findings across various patient populations and methodological differences. Sensitivity analyses supported the robustness of our findings. CONCLUSIONS Current evidence showed that pre-transplant SPECT MPI has significant prognostic value in identifying kidney transplant candidates at risk for MACE post-transplantation. Integrating SPECT MPI into preoperative assessments might enhance risk stratification and guide clinical decision-making. Prospective studies are needed to refine risk prediction models.
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Affiliation(s)
- Niels T Bloemendal
- Department of Surgery, Division of Organ Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Niek H J Prakken
- Medical Imaging Centre, Department of Radiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Barzi Gareb
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Stan Benjamens
- Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands
| | - Jan Stephan F Sanders
- Department of internal medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Riemer H J A Slart
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands; Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert A Pol
- Department of Surgery, Division of Organ Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
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11
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Malin J, Khan R, Manzano JMM, Wattanachayakul P, Geller A, Leguizamon R, John TA, Mclaren I, Prendergast A, Jarrett SA, Lo KB, Rangaswami J, Witzke C. Association of arteriovenous fistulae with precapillary pulmonary hypertension - A single center retrospective analysis of invasive hemodynamic parameters. Heart Lung 2024; 68:260-264. [PMID: 39116576 DOI: 10.1016/j.hrtlng.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Pulmonary hypertension (pH) is a well-known complication among patients with chronic kidney disease (CKD). Arteriovenous fistulae (AVF) have been associated with pH mainly by increasing cardiac output. However, the burden of precapillary pH in individuals with CKD and an AVF is unclear. OBJECTIVES To better and more fully understand the mechanism and development of precapillary pH in patients with AVF, as well as the consequences of precapillary pH in these patients. METHODS This was a large retrospective study of patients with CKD stage 4 or 5 who underwent right heart catheterization (RHC) from 2018 to 2023. The data were stratified according to the presence of AVF. To determine if AVF was independently associated with precapillary pH, we used a multivariable logistic regression analysis adjusting for demographics and potential comorbidities associated with precapillary pH, including diagnosis of chronic lung disease, obstructive sleep apnea, connective tissue disease, history of venous thromboembolism, chronic anemia, and heart failure. RESULTS Of 651 patients with CKD4 or CKD5, 145 (22 %) had AVF and 506 (78 %) did not have AVF. Within the AVF group, the median age was 64 years (IQR 54-71), and they were predominantly males (61 %, n = 88) and African American (77 %, n = 111). A total of 31 % (n = 45) had evidence of precapillary pH, 30 % (n = 43) of combined pH, and 14 % (n = 20) of isolated postcapillary pH. Compared to the non-AVF group, precapillary pH was more likely in the AVF group (31% vs 17 %, p < 0.0001). On multivariable analysis, AVF was independently associated with precapillary pH (OR 2.47, CI 1.56-3.89; p < 0.0001). The median time from dialysis initiation to RHC date (and precapillary pH diagnosis) was 6 years (IQR 3-8). CONCLUSION Based on RHC findings, almost one-third of patients with CKD and AVF had precapillary pH. The presence of AVF was independently associated with precapillary pH.
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Affiliation(s)
- John Malin
- Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States.
| | - Rasha Khan
- Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States
| | | | - Phuuwadith Wattanachayakul
- Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States
| | - Andrew Geller
- Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States
| | - Raul Leguizamon
- Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States
| | - Tara A John
- Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States
| | - Ian Mclaren
- Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States
| | - Alexander Prendergast
- Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States
| | - Simone A Jarrett
- Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States
| | - Kevin Bryan Lo
- Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Janani Rangaswami
- Department of Nephrology, George Washington University School of Medicine, Washington, DC 20037, United States
| | - Christian Witzke
- Department of Cardiology, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA 19141, United States
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12
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Gualandro DM, Fornari LS, Caramelli B, Abizaid AAC, Gomes BR, Tavares CDAM, Fernandes CJCDS, Polanczyk CA, Jardim C, Vieira CLZ, Pinho C, Calderaro D, Schreen D, Marcondes-Braga FG, Souza FD, Cardozo FAM, Tarasoutchi F, Carmo GAL, Kanhouche G, Lima JJGD, Bichuette LD, Sacilotto L, Drager LF, Vacanti LJ, Gowdak LHW, Vieira MLC, Martins MLFM, Lima MSM, Lottenberg MP, Aliberti MJR, Marchi MFDS, Paixão MR, Oliveira Junior MTD, Yu PC, Cury PR, Farsky PS, Pessoa RS, Siciliano RF, Accorsi TAD, Correia VM, Mathias Junior W. Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology - 2024. Arq Bras Cardiol 2024; 121:e20240590. [PMID: 39442131 DOI: 10.36660/abc.20240590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Affiliation(s)
- Danielle Menosi Gualandro
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
- University Hospital Basel, Basel - Suíça
| | - Luciana Savoy Fornari
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
- Fundação Zerbini, São Paulo, SP - Brasil
| | - Bruno Caramelli
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Alexandre Antonio Cunha Abizaid
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | - Carisi Anne Polanczyk
- Hospital de Clínicas da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS - Brasil
| | - Carlos Jardim
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Claudio Pinho
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP - Brasil
- Clinica Pinho, Campinas, SP - Brasil
| | - Daniela Calderaro
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Dirk Schreen
- Hospital São Carlos, Rede D'Or, Fortaleza, CE - Brasil
- Hospital Universitário Walter Cantidio da Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
- Instituto de Medicina Nuclear, Fortaleza, CE - Brasil
| | - Fabiana Goulart Marcondes-Braga
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Fábio de Souza
- Escola de Medicina e Cirurgia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ - Brasil
| | - Francisco Akira Malta Cardozo
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Gabriel Assis Lopes Carmo
- Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Evangélico de Belo Horizonte, Belo Horizonte, MG - Brasil
- Hospital Orizonti, Belo Horizonte, MG - Brasil
| | | | - José Jayme Galvão de Lima
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Luciana Dornfeld Bichuette
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Luciana Sacilotto
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
- Fundação Zerbini, São Paulo, SP - Brasil
| | - Luciano Ferreira Drager
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | - Luis Henrique Wolff Gowdak
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Márcio Silva Miguel Lima
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Marcos Pita Lottenberg
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | - Mauricio Felippi de Sá Marchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Milena Ribeiro Paixão
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Pai Ching Yu
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | - Rinaldo Focaccia Siciliano
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Tarso Augusto Duenhas Accorsi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Vinícius Machado Correia
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Wilson Mathias Junior
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
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13
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Dahl JN, Nielsen MB, Rasmussen LD, Ivarsen P, Williams MC, Svensson MHS, Birn H, Bøttcher M, Winther S. Coronary Plaque Characteristics in Patients With Chronic Kidney Failure: Impact on Cardiovascular Events and Mortality. Circ Cardiovasc Imaging 2024; 17:e017066. [PMID: 39344509 DOI: 10.1161/circimaging.124.017066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 09/04/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND In patients with coronary artery disease, coronary plaques with high-risk features and low-attenuation plaque burden are independent measures associated with major adverse cardiovascular events (MACEs). Patients with chronic kidney failure may have different coronary artery disease characteristics. The aim was to assess the association of coronary plaque characteristics and coronary artery disease extent with MACE and all-cause mortality in patients with chronic kidney failure. METHODS Potential kidney transplant candidates who underwent coronary computed tomography angiography as part of the cardiac screening program before kidney transplantation were included. We evaluated high-risk plaques and diameter stenosis semiqualitatively and quantified coronary artery calcium score and plaque burden (percentage atheroma volume). RESULTS In 484 patients with chronic kidney failure and few or no symptoms of coronary artery disease (mean age, 53±12 years; 62% men; 32% on dialysis), 56 (12%) patients suffered MACE and 69 (14%) patients died during a median follow-up of 4.9 years. High-risk plaques were present in 39 (70%) patients with MACE. Median calcified plaque burden was 3.7% in patients with MACE versus 0.2% in patients without MACE. The median low-attenuation plaque burden was 0.3% versus 0.03%, respectively. In semiqualitative analyses, the presence of high-risk plaque and a higher coronary artery calcium score were associated with increased risk of MACE (hazard ratio (HR), 2.0 [95% CI, 1.0-3.7]; P=0.040; HR, 1.2 [95% CI, 1.0-1.3]; P=0.014), respectively. Neither were associated with all-cause mortality. In quantified analysis, increasing levels of both calcified and low-attenuation plaque burdens were associated with risk of MACE (HR, 2.6 [95% CI, 1.8-3.7]; P<0.001; HR, 2.6 [95% CI, 1.5-4.5]; P=0.001 [per variable doubling, respectively]) and all-cause mortality (HR, 1.6 [95% CI, 1.2-2.1]; P=0.002; HR, 1.8 [95% CI, 1.1-3.0]; P=0.028, respectively). CONCLUSIONS In patients with chronic kidney failure, calcified and low-attenuation plaque burdens were independently associated with MACE and all-cause mortality, while high-risk plaques and coronary artery calcium score were only associated with MACE. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01344434.
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Affiliation(s)
- Jonathan Nørtoft Dahl
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark (J.N.D., L.D.R., M.B., S.W.)
- Department of Clinical Medicine (J.N.D., P.I., H.B., M.B., S.W.), Aarhus University, Denmark
| | - Marie B Nielsen
- Department of Biomedicine (M.B.N., H.B.), Aarhus University, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Denmark (M.B.N., P.I., H.B.)
| | - Laust D Rasmussen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark (J.N.D., L.D.R., M.B., S.W.)
- Department of Cardiology (L.D.R.), Aalborg University Hospital, Denmark
| | - Per Ivarsen
- Department of Clinical Medicine (J.N.D., P.I., H.B., M.B., S.W.), Aarhus University, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Denmark (M.B.N., P.I., H.B.)
| | - Michelle C Williams
- British Heart Foundation (BHF) Centre for Cardiovascular Science (M.C.W.), The University of Edinburgh, United Kingdom
- Edinburgh Imaging Facility Queen's Medical Research Institute (QMRI) (M.C.W.), The University of Edinburgh, United Kingdom
| | - My Hanna Sofia Svensson
- Department of Nephrology (M.H.S.S.), Aalborg University Hospital, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark (M.H.S.S.)
| | - Henrik Birn
- Department of Clinical Medicine (J.N.D., P.I., H.B., M.B., S.W.), Aarhus University, Denmark
- Department of Biomedicine (M.B.N., H.B.), Aarhus University, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Denmark (M.B.N., P.I., H.B.)
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark (J.N.D., L.D.R., M.B., S.W.)
- Department of Clinical Medicine (J.N.D., P.I., H.B., M.B., S.W.), Aarhus University, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark (J.N.D., L.D.R., M.B., S.W.)
- Department of Clinical Medicine (J.N.D., P.I., H.B., M.B., S.W.), Aarhus University, Denmark
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14
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Kanbay M, Guldan M, Ozbek L, Copur S, Covic AS, Covic A. Exploring the nexus: The place of kidney diseases within the cardiovascular-kidney-metabolic syndrome spectrum. Eur J Intern Med 2024; 127:1-14. [PMID: 39030148 DOI: 10.1016/j.ejim.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/25/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
Cardiovascular-kidney-metabolic (CKM) syndrome and chronic kidney disease (CKD) are two significant comorbidities affecting a large proportion of the general population with considerable crosstalk. In addition to substantial co-incidence of CKD and CKM syndrome in epidemiological studies, clinical and pre-clinical studies have identified similar pathophysiological pathways leading to both entities. Patients with CKM syndrome are more prone to develop acute kidney injury and CKD, while therapeutic alternatives and their success rates are considerably lower in such patient groups. Nevertheless, the association between CKM syndrome and CKD or ESKD is bidirectional rather than being a cause-effect relationship as patients with CKD are also prone to develop peripheral insulin resistance, high blood pressure, and dyslipidemia. Furthermore, such patients are less likely to receive kidney transplantation in addition to the higher allograft dysfunction risk. We hereby aim to evaluate the association in-between kidney diseases and CKM syndrome, including epidemiological data, pre-clinical studies with pathophysiological pathways, and potential therapeutic perspectives.
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Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
| | - Mustafa Guldan
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Lasin Ozbek
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Division of Internal Medicine, Koç University School of Medicine, Istanbul, Turkey
| | | | - Adrian Covic
- University of Medicine "Grigore T Popa" Iasi, Romania
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15
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Sekerak R, Lerner JBA, Garnett C, McEntegart M, Maehara A, Ali Z, Fall K, Mohan S, Ratner LE, Leon MB, Kirtane AJ, Moses J, Prasad M. Outcomes of ultra-low contrast percutaneous coronary intervention in patients with advanced chronic kidney disease. Catheter Cardiovasc Interv 2024; 104:227-233. [PMID: 38932577 DOI: 10.1002/ccd.31128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/17/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Coronary angiography and percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD) is associated with increased risk of contrast induced nephropathy (CIN) and requirement for renal replacement therapy (RRT). OBJECTIVES We aimed to evaluate our single center experience of ultra-low contrast PCI in patients with CKD and to characterize 1 year outcomes. METHODS We performed a retrospective analysis of ultra-low contrast PCI at our institution between 2016 and 2022. Patients with CKD3b-5 (eGFR <45 mL/min/1.73m2), not on RRT who underwent ultra-low contrast PCI ( < 30 mL of contrast during PCI) were included. Primary outcomes included change in eGFR post-procedurally, and death, RRT requirement, and major adverse cardiac events (MACE) at 1 year follow-up. RESULTS One hundred patients were included in the study. The median age was 67 years old and 28% were female. The median baseline eGFR was 21.5 mL/min/1.73m2 (IQR 14.08-32.0 mL/min/1.73m2). A median of 8.0 mL (IQR 0-15 mL) of contrast was used during PCI. Median contrast use to eGFR ratio was 0.37 (IQR 0-0.59). There was no significant difference between pre-and postprocedure eGFR (p = 0.84). At 1 year, 8% of patients died, 11% required RRT and 33% experienced MACE. The average time of RRT initiation was 7 months post-PCI. Forty-four patients were undergoing renal transplant evaluation, of which 17 (39%) received a transplant. CONCLUSIONS In patients with advanced CKD, ultra-low contrast PCI is feasible and safe with minimal need for peri-procedural RRT. Moreover, ultra-low contrast PCI may allow for preservation of renal function in anticipation of renal transplantation.
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Affiliation(s)
| | | | | | | | - Akiko Maehara
- Columbia University Medical Center, New York, New York, USA
| | - Ziad Ali
- St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Khady Fall
- Columbia University Medical Center, New York, New York, USA
| | - Sumit Mohan
- Columbia University Medical Center, New York, New York, USA
| | - Lloyd E Ratner
- Columbia University Medical Center, New York, New York, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, New York, USA
| | - Ajay J Kirtane
- Columbia University Medical Center, New York, New York, USA
| | - Jeffrey Moses
- Columbia University Medical Center, New York, New York, USA
| | - Megha Prasad
- Columbia University Medical Center, New York, New York, USA
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16
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Ho T, Vallabhajosyula S, Nagaraja V. Renal Transplantation Offers Long-Term Cardiac Protection With a Potential for Further Improvement. Heart Lung Circ 2024; 33:913-914. [PMID: 39032975 DOI: 10.1016/j.hlc.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Affiliation(s)
- Tiffany Ho
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Saraschandra Vallabhajosyula
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Vinayak Nagaraja
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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17
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Biolato M, Miele L, Marrone G, Tarli C, Liguori A, Calia R, Addolorato G, Agnes S, Gasbarrini A, Pompili M, Grieco A. Frequency of and reasons behind non-listing in adult patients referred for liver transplantation: Results from a retrospective study. World J Transplant 2024; 14:92376. [PMID: 38947971 PMCID: PMC11212587 DOI: 10.5500/wjt.v14.i2.92376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Few studies have evaluated the frequency of and the reasons behind the refusal of listing liver transplantation candidates. AIM To assess the ineligibility rate for liver transplantation and its motivations. METHODS A single-center retrospective study was conducted on adult patients which entailed a formal multidisciplinary assessment for liver transplantation eligibility. The predictors for listing were evaluated using multivariable logistic regression. RESULTS In our center, 314 patients underwent multidisciplinary work-up before liver transplantation enlisting over a three-year period. The most frequent reasons for transplant evaluation were decompensated cirrhosis (51.6%) and hepatocellular carcinoma (35.7%). The non-listing rate was 53.8% and the transplant rate was 34.4% for the whole cohort. Two hundred and five motivations for ineligibility were collected. The most common contraindications were psychological (9.3%), cardiovascular (6.8%), and surgical (5.9%). Inappropriate or premature referral accounted for 76 (37.1%) cases. On multivariable analysis, a referral from another hospital (OR: 2.113; 95%CI: 1.259-3.548) served as an independent predictor of non-listing. CONCLUSION A non-listing decision occurred in half of our cohort and was based on an inappropriate or premature referral in one case out of three. The referral from another hospital was taken as a strong predictor of non-listing.
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Affiliation(s)
- Marco Biolato
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Luca Miele
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Giuseppe Marrone
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Claudia Tarli
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Antonio Liguori
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Rosaria Calia
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Giovanni Addolorato
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Salvatore Agnes
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Maurizio Pompili
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Antonio Grieco
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy
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18
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Toftholm MH, Højstrup S, Talleruphuus U, Marner L, Bjerking L, Jakobsen L, Christiansen EH, Bouchelouche K, Galatius S, Prescott E, Skak-Hansen KW. 82-rubidium positron emission tomography determined myocardial flow reserve and outcomes following cardiac revascularisation - A multicentre registry study. Int J Cardiol 2024; 405:131865. [PMID: 38365013 DOI: 10.1016/j.ijcard.2024.131865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Finding patients with chronic coronary syndromes (CCS) whom revascularization could benefit, is complicated. Myocardial flow reserve (MFR), a measurement of myocardial perfusion, has proven prognostic value on survival and risk of major adverse cardiac events (MACE). We investigated if MFR identifies who may benefit from revascularization. METHODS Among 7462 patients from Danish hospitals examined with 82Rb PET between January 2018 and August 2020, patients with ≥5% reversible perfusion defects were followed for MACE and all-cause mortality. Associations between revascularisation (within 90 days) and outcomes according to MFR (< and ≥ 2) was assessed by Cox regression adjusted by inverse probability weighting for demographics, cardiovascular risk factors, comorbidities, and 82Rb PET variables. RESULTS Of 1806 patients with ≥5% reversible perfusion defect, 893 (49%) had MFR < 2 and 491 underwent revascularisation (36.6% in MFR < 2 versus 17.9% MFR ≥ 2, p < 0.001). During a median follow-up of 37.0 [31.0-45.8 IQR] months, 251 experienced a MACE and 173 died. Revascularisation was associated with lower adjusted risk of all-cause mortality (hazard ratio [HR], 0.51 [95% CI, 0.30-0.88], p = 0.015) and MACE (HR, 0.54 [0.33-0.87], p = 0.012) in patients with MFR < 2 but not MFR ≥ 2 for all-cause mortality (HR 1.33 [0.52-3.40], p = 0.542) and MACE (HR 1.50 [0.79-2.84], p = 0.211). MFR significantly modified the association between revascularisation and MACE, but not all-cause mortality (interaction p-value 0.021 and 0.094, respectively). CONCLUSIONS Revascularization was associated with improved prognosis among patients with impaired MFR. No association was seen in patients with normal MFR. In patients with regional ischemia, MFR may identify patients with a prognostic benefit from revascularization.
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Affiliation(s)
- M H Toftholm
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark.
| | - S Højstrup
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark.
| | - U Talleruphuus
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Clinical Physiology and Nuclear Medicine, Denmark
| | - L Marner
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Clinical Physiology and Nuclear Medicine, Denmark
| | - L Bjerking
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
| | - L Jakobsen
- Aarhus University Hospital, Department of Cardiology, Denmark
| | | | - K Bouchelouche
- Aarhus University Hospital, Department of Nuclear Medicine & PET Centre, Denmark
| | - S Galatius
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
| | - E Prescott
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
| | - K W Skak-Hansen
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
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19
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Martinez-Perez S, McCluskey SA, Davierwala PM, Kalra S, Nguyen E, Bhat M, Borosz C, Luzzi C, Jaeckel E, Neethling E. Perioperative Cardiovascular Risk Assessment and Management in Liver Transplant Recipients: A Review of the Literature Merging Guidelines and Interventions. J Cardiothorac Vasc Anesth 2024; 38:1015-1030. [PMID: 38185566 DOI: 10.1053/j.jvca.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024]
Abstract
Liver transplantation (LT) is the second most performed solid organ transplant. Coronary artery disease (CAD) is a critical consideration for LT candidacy, particularly in patients with known CAD or risk factors, including metabolic dysfunction associated with steatotic liver disease. The presence of severe CAD may exclude patients from LT; therefore, precise preoperative evaluation and interventions are necessary to achieve transplant candidacy. Cardiovascular complications represent the earliest nongraft-related cause of death post-transplantation. Timely intervention to reduce cardiovascular events depends on adequate CAD screening. Coronary disease screening in end-stage liver disease is challenging because standard noninvasive CAD screening tests have low sensitivity due to hyperdynamic state and vasodilatation. As a result, there is overuse of invasive coronary angiography to exclude severe CAD. Coronary artery calcium scoring using a computed tomography scan is a tool for the prediction of cardiovascular events, and can be used to achieve risk stratification in LT candidates. Recent literature shows that qualitative assessment on both noncontrast- and contrast-enhanced chest computed tomography can be used instead of calcium score to assess the presence of coronary calcium. With increasing prevalence, protocols to address CAD in LT candidates must be reconsidered. Percutaneous coronary intervention could allow a shorter duration of dual-antiplatelet therapy in simple lesions, with safer perioperative outcomes. Hybrid coronary revascularization is an option for high-risk LT candidates with multivessel disease nonamenable to percutaneous coronary intervention. The objective of this review is to evaluate existing methods for preoperative cardiovascular risk stratification, and to describe interventions before surgery to optimize patient outcomes and reduce cardiovascular event risk.
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Affiliation(s)
- Selene Martinez-Perez
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network and Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stuart A McCluskey
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network and Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Piroze M Davierwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre Toronto, General Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sanjog Kalra
- Division of Cardiology, Interventional Cardiology Section, Peter Munk Cardiac Center Toronto General Hospital, University Health Network and Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elsie Nguyen
- Department of Medical Imaging, Cardiothoracic Imaging Division Lead, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mamatha Bhat
- Department of Gastroenterology, Hepatology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Borosz
- Department of Gastroenterology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Carla Luzzi
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network and Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elmar Jaeckel
- Department of Gastroenterology, Ajmera Transplant Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Elmari Neethling
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network and Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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20
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Soldera J, Corso LL, Rech MM, Ballotin VR, Bigarella LG, Tomé F, Moraes N, Balbinot RS, Rodriguez S, Brandão ABDM, Hochhegger B. Predicting major adverse cardiovascular events after orthotopic liver transplantation using a supervised machine learning model: A cohort study. World J Hepatol 2024; 16:193-210. [PMID: 38495288 PMCID: PMC10941741 DOI: 10.4254/wjh.v16.i2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/27/2023] [Accepted: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Liver transplant (LT) patients have become older and sicker. The rate of post-LT major adverse cardiovascular events (MACE) has increased, and this in turn raises 30-d post-LT mortality. Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients. AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort. METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center. We developed a predictive model for post-LT MACE (defined as a composite outcome of stroke, new-onset heart failure, severe arrhythmia, and myocardial infarction) using the extreme gradient boosting (XGBoost) machine learning model. We addressed missing data (below 20%) for relevant variables using the k-nearest neighbor imputation method, calculating the mean from the ten nearest neighbors for each case. The modeling dataset included 83 features, encompassing patient and laboratory data, cirrhosis complications, and pre-LT cardiac assessments. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC). We also employed Shapley additive explanations (SHAP) to interpret feature impacts. The dataset was split into training (75%) and testing (25%) sets. Calibration was evaluated using the Brier score. We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting. Scikit-learn and SHAP in Python 3 were used for all analyses. The supplementary material includes code for model development and a user-friendly online MACE prediction calculator. RESULTS Of the 537 included patients, 23 (4.46%) developed in-hospital MACE, with a mean age at transplantation of 52.9 years. The majority, 66.1%, were male. The XGBoost model achieved an impressive AUROC of 0.89 during the training stage. This model exhibited accuracy, precision, recall, and F1-score values of 0.84, 0.85, 0.80, and 0.79, respectively. Calibration, as assessed by the Brier score, indicated excellent model calibration with a score of 0.07. Furthermore, SHAP values highlighted the significance of certain variables in predicting postoperative MACE, with negative noninvasive cardiac stress testing, use of nonselective beta-blockers, direct bilirubin levels, blood type O, and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level. These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE, making it a valuable tool for clinical practice. CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE, using both cardiovascular and hepatic variables. The model demonstrated impressive performance, aligning with literature findings, and exhibited excellent calibration. Notably, our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data, reinforcing the model's value as a reliable tool for predicting post-LT MACE in clinical practice.
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Affiliation(s)
- Jonathan Soldera
- Post Graduate Program at Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
- Postgraduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil.
| | - Leandro Luis Corso
- Department of Engineering, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
| | - Matheus Machado Rech
- School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
| | | | | | - Fernanda Tomé
- Department of Engineering, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
| | - Nathalia Moraes
- Department of Engineering, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
| | | | - Santiago Rodriguez
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Ajacio Bandeira de Mello Brandão
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Bruno Hochhegger
- Postgraduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
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21
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Corr M, Orr A, Courtney AE. The Minimisation of Cardiovascular Disease Screening for Kidney Transplant Candidates. J Clin Med 2024; 13:953. [PMID: 38398266 PMCID: PMC10889488 DOI: 10.3390/jcm13040953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Background: There is increasing evidence that cardiac screening prior to kidney transplantation does not improve its outcomes. However, risk aversion to perioperative events means that, in practice, testing remains common, limiting the availability of 'real-world' data to support any change. Our objective was to assess perioperative and 1-year post-transplant cardiovascular events in a kidney transplant candidate cohort who received minimal cardiovascular screening. Methods: The retrospective cohort study included all adult kidney-only transplant recipients in a single UK region between January 2015 and December 2021. Kidney transplant recipients asymptomatic of cardiac disease, even those with established risk factors, did not receive cardiac stress testing. The perioperative and 1-year post-transplant cardiovascular event incidences were examined. Logistic regression was used to identify variables of statistical significance that predicted cardiovascular or cerebrovascular events. Results: A total of 895 recipients fulfilled the inclusion criteria. Prior to transplantation, 209 (23%) recipients had an established cardiac diagnosis, and 193 (22%) individuals had a diagnosis of diabetes. A total of 18 (2%) patients had a perioperative event, and there was a 5.7% incidence of cardiovascular events 1 year post-transplantation. The cardiovascular mortality rate was 0.0% perioperatively, 0.2% at 3 months post-transplant, and 0.2% at 1 year post-transplant. Conclusions: This study demonstrates comparable rates of cardiovascular events despite reduced screening in asymptomatic recipients. It included higher risk individuals who may, on the basis of screening results, have been excluded from transplantation in other programmes. It provides further evidence that extensive cardiac screening prior to kidney transplantation is unlikely to be offset by reduced rates of cardiovascular events.
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Affiliation(s)
- Michael Corr
- Centre for Public Health, Institute of Clinical Sciences B, Royal Victoria Hospital, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Amber Orr
- Barnsley Hospital NHS Foundation Trust, Barnsley S75 2EP, UK
| | - Aisling E. Courtney
- Regional Nephrology & Transplant Unit, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK
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22
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Rajnochova Bloudickova S, Janek B, Machackova K, Hruba P. Standardized risk-stratified cardiac assessment and early posttransplant cardiovascular complications in kidney transplant recipients. Front Cardiovasc Med 2024; 11:1322176. [PMID: 38327495 PMCID: PMC10847279 DOI: 10.3389/fcvm.2024.1322176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in kidney transplant recipient (KTR). There is a dearth of standardized guidelines on optimal cardiovascular evaluation of transplant candidates. Methods This single-center cohort study aims to determine the effectiveness of our standardized risk-stratified pretransplant cardiovascular screening protocol, which includes coronary angiography (CAG), in identifying advanced CVD, the proper pretransplant management of which could lead to a reduction in the incidence of major cardiac events (MACE) in the early posttransplant period. Results Out of the total 776 KTR transplanted between 2017 and 2019, CAG was performed on 541 patients (69.7%), of whom 22.4% were found to have obstructive coronary artery disease (CAD). Asymptomatic obstructive CAD was observed in 70.2% of cases. In 73.6% of cases, CAG findings resulted in myocardial revascularization. MACE occurred in 5.6% (N = 44) of the 23 KTR with pretransplant CVD and 21 without pretransplant CVD. KTR with posttransplant MACE occurrence had significantly worse kidney graft function at the first year posttransplant (p = 0.00048) and worse patient survival rates (p = 0.0063) during the 3-year follow-up period compared with KTR without MACE. After adjustment, the independent significant factors for MACE were arrhythmia (HR 2.511, p = 0.02, 95% CI 1.158-5.444), pretransplant history of acute myocardial infarction (HR 0.201, p = 0.046, 95% CI 0.042-0.970), and pretransplant myocardial revascularization (HR 0.225, p = 0.045, 95% CI 0.052-0.939). Conclusion Asymptomatic CVD is largely prevalent in KTR. Posttransplant MACE has a negative effect on grafts and patient outcomes. Further research is needed to assess the benefits of pretransplant myocardial revascularization in asymptomatic kidney transplant candidates.
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Affiliation(s)
| | - Bronislav Janek
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Karolina Machackova
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petra Hruba
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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23
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Huck DM, Weber B, Schreiber B, Pandav J, Parks S, Hainer J, Brown JM, Divakaran S, Blankstein R, Dorbala S, Trinquart L, Chandraker A, Di Carli MF. Comparative Effectiveness of PET and SPECT MPI for Predicting Cardiovascular Events After Kidney Transplant. Circ Cardiovasc Imaging 2024; 17:e015858. [PMID: 38227694 PMCID: PMC10794031 DOI: 10.1161/circimaging.123.015858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Advanced chronic kidney disease is associated with high cardiovascular risk, even after kidney transplant. Pretransplant cardiac testing may identify patients who require additional assessment before transplant or would benefit from risk optimization. The objective of the current study was to determine the relative prognostic utility of pretransplant positron emission tomography (PET) and single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for posttransplant major adverse cardiovascular events (MACEs). METHODS We retrospectively followed patients who underwent MPI before kidney transplant for the occurrence of MACE after transplant including myocardial infarction, stroke, heart failure, and cardiac death. An abnormal MPI result was defined as a total perfusion deficit >5% of the myocardium. To determine associations of MPI results with MACE, we utilized Cox hazard regression with propensity weighting for PET versus SPECT with model factors, including demographics and cardiovascular risk factors. RESULTS A total of 393 patients underwent MPI (208 PET and 185 SPECT) and were followed for a median of 5.9 years post-transplant. Most were male (58%), median age was 58 years, and there was a high burden of hypertension (88%) and diabetes (33%). A minority had abnormal MPI (n=58, 15%). In propensity-weighted hazard regression, abnormal PET result was associated with posttransplant MACE (hazard ratio, 3.02 [95% CI, 1.78-5.11]; P<0.001), while there was insufficient evidence of an association of abnormal SPECT result with MACE (1.39 [95% CI, 0.72-2.66]; P=0.33). The explained relative risk of the PET result was higher than the SPECT result (R2 0.086 versus 0.007). Normal PET was associated with the lowest risk of MACE (2.2%/year versus 3.6%/year for normal SPECT; P<0.001). CONCLUSIONS Kidney transplant recipients are at high cardiovascular risk, despite a minority having obstructive coronary artery disease on MPI. PET MPI findings predict posttransplant MACE. Normal PET may better discriminate lower risk patients compared with normal SPECT, which should be confirmed in a larger prospective study.
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Affiliation(s)
- Daniel M Huck
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Division (D.M.H., B.W., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbalat, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brittany Weber
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Division (D.M.H., B.W., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbalat, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brittany Schreiber
- Division of Nephrology (B.S., J.P., A.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jay Pandav
- Division of Nephrology (B.S., J.P., A.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sean Parks
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbalat, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Nuclear Medicine and Molecular Imaging (S.P., J.H., S. Divakaran, S. Dorbala, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jon Hainer
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbalat, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Nuclear Medicine and Molecular Imaging (S.P., J.H., S. Divakaran, S. Dorbala, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jenifer M Brown
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Division (D.M.H., B.W., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbalat, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sanjay Divakaran
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Division (D.M.H., B.W., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbalat, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Nuclear Medicine and Molecular Imaging (S.P., J.H., S. Divakaran, S. Dorbala, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ron Blankstein
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Division (D.M.H., B.W., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbalat, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sharmila Dorbala
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Division (D.M.H., B.W., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Nuclear Medicine and Molecular Imaging (S.P., J.H., S. Divakaran, S. Dorbala, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ludovic Trinquart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (L.T.)
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA (L.T.)
| | - Anil Chandraker
- Division of Nephrology (B.S., J.P., A.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marcelo F Di Carli
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Division (D.M.H., B.W., J.M.B., S. Divakaran, R.B., S. Dorbala, M.F.D.C.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- CV Imaging Program (D.M.H., B.W., S.P., J.H., J.M.B., S. Divakaran, R.B., S. Dorbalat, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Nuclear Medicine and Molecular Imaging (S.P., J.H., S. Divakaran, S. Dorbala, M.F.D.C.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Gutiérrez-Villamil C, Zuluaga-Arbeláez C, Hernández G, Hernández-Hidalgo N, Marín-Oyaga V. Myocardial perfusion scintigraphy in the assessment of cardiovascular risk in adult liver transplantation. Rev Esp Med Nucl Imagen Mol 2024; 43:1-5. [PMID: 37726078 DOI: 10.1016/j.remnie.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/10/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION The non-invasive diagnostic study of cardiovascular risk in patients who are going to undergo liver transplantation is not clear, especially in asymptomatic patients. Regarding myocardial perfusion scintigraphy (MPS), it has been thought that the impaired vasodilator reserve in these patients may reduce its performance. The objective is to assess the role of the MPS in the pre-surgical evaluation of patients who are going to undergo liver transplantation. MATERIAL AND METHODS Retrospective, descriptive and observational study was designed. All adult patients undergoing liver transplantation between 2017 and 2021 who had previous MPS were included. The findings of MPS were described and correlated with the findings of invasive angiography and with the appearance or not of peri- and post-transplant cardiovascular events. RESULTS There were a total of 188 transplanted patients (mean age: 57 years, SD: 12), 178 had previous myocardial perfusion, 82 (46%) patients had no cardiovascular risk factors, and 5 (2.8%) had a history of coronary disease. Of the MPS, 177 were with dipyridamole stress performed on average 10 months before transplantation. Only 17/178 (9.5%) studies were abnormal. The mean follow-up was 38 months (SD: 10). Of the patients with normal MPS, only 2 (1.2%) presented cardiovascular events, both with studies performed more than 2 years before the procedure. There were no deaths of cardiovascular origin. CONCLUSIONS MPS is a safe and reliable technique for cardiovascular assessment of patients who are candidates for liver transplantation, given the low rate of false negatives during follow-up.
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Affiliation(s)
- C Gutiérrez-Villamil
- Servicio de Medicina Nuclear, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
| | - C Zuluaga-Arbeláez
- Servicio de Medicina Nuclear, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
| | - G Hernández
- Servicio de Gastroenterología, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
| | | | - V Marín-Oyaga
- Servicio de Medicina Nuclear, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia.
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25
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Nielsen MB, Dahl JN, Jespersen B, Ivarsen P, Birn H, Winther S. External Validation of Proposed American Heart Association Algorithm for Cardiovascular Screening Before Kidney Transplantation. J Am Heart Assoc 2023; 12:e031150. [PMID: 38084711 PMCID: PMC10863782 DOI: 10.1161/jaha.123.031150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/22/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Screening for cardiovascular disease is currently recommended before kidney transplantation. The present study aimed to validate the proposed algorithm by the American Heart Association (AHA-2022) considering cardiovascular findings and outcomes in kidney transplant candidates, and to compare AHA-2022 with the previous recommendation (AHA-2012). METHODS AND RESULTS We applied the 2 screening algorithms to an observational cohort of kidney transplant candidates (n=529) who were already extensively screened for coronary heart disease by referral to cardiac computed tomography between 2014 and 2019. The cohort was divided into 3 groups as per the AHA-2022 algorithm, or into 2 groups as per AHA-2012. Outcomes were degree of coronary heart disease, revascularization rate following screening, major adverse cardiovascular events, and all-cause death. Using the AHA-2022 algorithm, 69 (13%) patients were recommended for cardiology referral, 315 (60%) for cardiac screening, and 145 (27%) no further screening. More patients were recommended cardiology referral or screening compared with the AHA-2012 (73% versus 53%; P<0.0001). Patients recommended cardiology referral or cardiac screening had a higher risk of major adverse cardiovascular events (hazard ratio [HR], 5.5 [95% CI, 2.8-10.8]; and HR, 2.1 [95% CI, 1.2-3.9]) and all-cause death (HR, 12.0 [95% [CI, 4.6-31.4]; and HR, 5.3 [95% CI, 2.1-13.3]) compared with patients recommended no further screening, and were more often revascularized following initial screening (20% versus 7% versus 0.7%; P<0.001). CONCLUSIONS The AHA-2022 algorithm allocates more patients for cardiac referral and screening compared with AHA-2012. Furthermore, the AHA-2022 algorithm effectively discriminates between kidney transplant candidates at high, intermediate, and low risk with respect to major adverse cardiovascular events and all-cause death.
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Affiliation(s)
- Marie Bodilsen Nielsen
- Department of BiomedicineAarhus UniversityAarhusDenmark
- Department of Renal MedicineAarhus University HospitalAarhusDenmark
| | - Jonathan Nørtoft Dahl
- Department of Cardiology, Gødstrup HospitalHerningDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Bente Jespersen
- Department of Renal MedicineAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Per Ivarsen
- Department of Renal MedicineAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Henrik Birn
- Department of BiomedicineAarhus UniversityAarhusDenmark
- Department of Renal MedicineAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Simon Winther
- Department of Cardiology, Gødstrup HospitalHerningDenmark
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26
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Yang KJ, Fu HY, Chang CJ, Wang TC, Wang CH, Chou NK, Wu IH, Hsu RB, Huang SC, Yu HY, Chen YS, Chi NH. Long-term outcomes of mitral valve replacement in dialysis patients: evidence from a nationwide database. Int J Surg 2023; 109:3778-3787. [PMID: 37678297 PMCID: PMC10720870 DOI: 10.1097/js9.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND To compare the late outcomes between mechanical and bioprostheses after isolated mitral valve replacement (MVR) in dialysis-dependent patients. METHODS A nationwide propensity-matched retrospective cohort study was conducted involving dialysis patients who underwent primary mitral replacement between 2001 and 2018. Ten-year postoperative outcomes were compared between mitral bioprosthesis and mechanical prosthesis using the Cox proportional hazard model and restricted mean survival time (RMST). RESULTS The all-cause mortality was 20.8 and 13.0 events per 100 person-years, with a 10-year RMST of 7.40 and 7.31 years for bioprosthesis and mechanical prosthesis, respectively. Major bleeding was the most common adverse event for both bioprosthesis and mechanical prosthesis, with an incidence rate of 19.5 and 19.1 events per 100 person-years, respectively. The incidence of valve reoperation was higher among those who received bioprosthesis (0.55 events per 100 person-years). After 1:1 matching, the all-cause mortality was 15.45 and 14.54 events per 100 person-years for bioprosthesis and mechanical prosthesis, respectively. The RMST at 10 years was comparable between the two groups after matching (5.10 years for bioprosthesis vs. 4.59 years for mechanical prosthesis), with an RMST difference of -0.03. Further, no difference was observed in the incidence of major adverse valve-related events between bioprosthesis and mechanical valves. However, bioprosthesis was associated with a higher incidence of mitral valve reoperation among all major adverse events (RMST difference -0.24 years, 95% CI -0.48 to -0.01, P =0.047). CONCLUSIONS This study found no association between valve selection and long-term survival outcomes in dialysis patients after MVR. However, bioprosthetic valves may be associated with a slightly higher incidence of reoperation, while other valve-related adverse events, including major bleeding and stroke, were comparable between the two types of prostheses.
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Affiliation(s)
- Kelvin J. Yang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Hsun-Yi Fu
- Department of Cardiovascular Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu
| | - Chia-Jui Chang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University
- Department of Pharmacy, National Taiwan University Cancer Center
| | - Ting-Chuan Wang
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Chih-Hsien Wang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Nai-Kuan Chou
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - I-Hui Wu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Ron-Bin Hsu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Shu-Chien Huang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Hsi-Yu Yu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
| | - Nai-Hsin Chi
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei
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27
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Kleb C, Sims OT, Fares M, Ruthmann N, Ansari K, Esfeh JM. Screening Modalities for Coronary Artery Disease in Liver Transplant Candidates: A Review of the Literature. J Cardiothorac Vasc Anesth 2023; 37:2611-2620. [PMID: 37690949 DOI: 10.1053/j.jvca.2023.08.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/16/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023]
Abstract
Patients with cirrhosis undergoing liver transplant (LT) are at high risk of postoperative cardiopulmonary complications. It is known that patients with coronary artery disease (CAD) have greater rates of post-LT morbidity and mortality than patients without CAD. Thus, identifying significant CAD in LT candidates is of the utmost importance to optimize survival posttransplant. Consensus is lacking on the ideal screening test for CAD in LT candidates. Traditional exercise and many pharmacologic stress tests are impractical and inaccurate in patients with cirrhosis due to their unique physiology. The purpose of this review is to describe different screening modalities for CAD among LT candidates. The background, diagnostic accuracy, and limitations of each screening modality are described to achieve this goal.
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Affiliation(s)
- Cerise Kleb
- Department of Gastroenterology, University of Maryland Medical Center, Baltimore, MD.
| | - Omar T Sims
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Maan Fares
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Nicholas Ruthmann
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Kianoush Ansari
- Department of Diagnostic Radiology, University Hospital Cleveland Medical Center, Cleveland, OH
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH
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28
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Iyengar A, Song C, Weingarten N, Rekhtman D, Herbst DA, Shin M, Helmers MR, Atluri P. Prosthesis Choice in Dialysis Patients Undergoing Mitral Valve Replacement. Ann Thorac Surg 2023; 116:963-970. [PMID: 37245789 DOI: 10.1016/j.athoracsur.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Patients with renal disease on dialysis have significant comorbidity limiting life expectancy; however, these patients may experience accelerated prosthetic valve degeneration. The purpose of this study was to examine the impact of prosthesis choice on outcomes in dialysis patients undergoing mitral valve replacement (MVR) at our high-volume academic center. METHODS Adults undergoing MVR were retrospectively reviewed between January 2002 and November 2019. Patients were included if they had documented renal failure and dialysis requirements before presentation. Patients were stratified by mechanical vs bioprosthetic prosthesis. Death and recurrent severe valve failure (3+ or greater) or redo mitral operation were used as primary outcomes. RESULTS There were 177 dialysis patients identified who underwent MVR. Of these, 118 (66.7%) received bioprosthetic valves, whereas 59 (33.3%) received mechanical valves. Those who received mechanical valves were younger (48 vs 61 years; P < .001) and had less diabetes (32% vs 51%; P = .019). Prevalence of endocarditis and atrial fibrillation was similar. Postoperative length of stay was not different between groups. Risk-adjusted hazard for 5-year mortality was similar between groups (P = .668). Early mortality was high, with both groups having <50% actuarial survival at 2 years. No differences were noted in rates of structural valve deterioration or reintervention. More stroke events were noted on follow-up in patients receiving mechanical valves (15% vs 6%; P = .041). Endocarditis was the leading reason for reintervention; 4 patients received repeated surgery for bioprosthetic valve failure. CONCLUSIONS MVR in dialysis patients carries significant morbidity and increased midterm mortality. Decreased life expectancy should be considered in the tailoring of prosthesis choice to dialysis-dependent patients.
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Affiliation(s)
- Amit Iyengar
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cindy Song
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noah Weingarten
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Rekhtman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Herbst
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Max Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark R Helmers
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
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29
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Deo AS, Manjunath D, Prasad A, Deepa D. Perioperative anaesthesia management of renal transplant recipients - A national cross-sectional survey. Indian J Anaesth 2023; 67:S288-S291. [PMID: 38187965 PMCID: PMC10768906 DOI: 10.4103/ija.ija_492_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Alka S. Deo
- Department of Anaesthesiology, NU Hospitals, Bangalore, Karnataka, India
| | - Deepti Manjunath
- Department of Anaesthesiology, NU Hospitals, Bangalore, Karnataka, India
| | - Ambika Prasad
- Department of Anaesthesiology, NU Hospitals, Bangalore, Karnataka, India
| | - D Deepa
- Department of Anaesthesiology, NU Hospitals, Bangalore, Karnataka, India
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30
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Nielsen MB, Iversen MS, Derai A, Dahl JN, Jespersen B, Ivarsen P, Winther S, Birn H. The Diagnostic Yield and Clinical Impact of Systematic Screening of Kidney Transplant Candidates by Cardiac Computed Tomography: A Cohort Study. Transplant Proc 2023; 55:2102-2109. [PMID: 37777365 DOI: 10.1016/j.transproceed.2023.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/21/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Although cardiovascular screening of kidney transplant candidates is recommended, the optimal approach is debated. Previous studies show that noninvasive imaging provides prognostic information, but systematic screening may have less recognized effects, such as additional investigations, incidental findings, procedural complications, and delay of transplantation. To address this, we characterized the diagnostic yield and clinical implications of systematic screening for cardiovascular disease using cardiac computed tomography (CT) in potential kidney transplant candidates. METHODS This was a single-center, observational cohort study including all potential kidney transplant candidates >40 years of age or with diabetes or on dialysis treatment for >5 years, systematically referred to cardiac computed tomography (CT; non-contrast CT and coronary CT angiography) between 2014 and 2019 before evaluation for kidney transplantation at Aarhus University Hospital. Patient records were examined for data on baseline characteristics, additional investigations and complications, plasma creatinine, dialysis initiation, time until wait-listing, and incidental findings. RESULTS Of 473 patients who underwent cardiac CT, additional cardiac investigations were performed in 156 (33%), and 32 (7%) were revascularized. Twenty-two patients had significant incidental nonvascular findings on cardiac CT. No patient was rejected for transplantation based on cardiac CT. In patients not yet on dialysis, the slope in the estimated glomerular filtration rate decline did not change significantly after coronary CT angiography. CONCLUSION Screening by cardiac CT led to additional cardiac investigations in one-third of patients; only a few patients were revascularized, with unknown benefits in asymptomatic patients. Cardiac CT was safe in this population; however, the clinical consequences of the screening were limited.
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Affiliation(s)
- Marie B Nielsen
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark.
| | - Malene S Iversen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Amal Derai
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Jonathan N Dahl
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Per Ivarsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Henrik Birn
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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31
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Arabi Z, Tawhari MH, Al Rajih HS, Youssouf TM, Abdulgadir MY. Findings of Cardiovascular Workup of Kidney Transplant Candidates: A Retrospective Study of a Single-Center in Saudi Arabia. Int J Nephrol 2023; 2023:4653069. [PMID: 37854308 PMCID: PMC10581843 DOI: 10.1155/2023/4653069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
Background There are limited data about the prevalence of cardiovascular (CV) risk factors and the findings of CV workup among kidney transplant (KTx) recipients (KTRs) in Saudi Arabia. Methods A single-center retrospective study of KTRs who underwent KTx from 2017 to 2020 was performed. We reviewed the prevalence of CV risk factors and the results of the pre-KTx CV workup which was derived from the American Heart Association guidelines. Results We included 254 KTRs. The mean age was 43.1 ± 15.9 years, and 55.5% were men and 79.5% were living-donor KTRs. Pre-emptive KTx was 9.8%, peritoneal dialysis was 11.8%, and hemodialysis was 78.3% (arteriovenous fistula: 33.1% versus hemodialysis catheter: 66.9%). The mean dialysis vintage was 4.8 ± 3.3 years for deceased-donor KTRs versus 2.4 ± 2.6 years for living-donor KTRs. CV risk factors were hypertension: 76%, diabetes: 40.6% (type 1 : 25.2% versus type 2 : 74.7%), hyperlipidemia (low-density lipoprotein >2.6 mmol/L): 40.2%, coronary artery disease (CAD): 12.6%, smoking: 9.1%, peripheral vascular disease: 2.8%, and cerebral vascular disease: 2.4%. The prevalence of obesity stage 1 was 19.7% and obesity stage 2 was 4%. Left ventricular hypertrophy was present in 38.5%. The ejection fraction was abnormal (<55%) in 22%. Abnormal wall motion was present in 34 patients (13.4%). A cardiac (PET-CT) stress test was conducted on 129 patients (50.8%) which showed abnormal perfusion in 37 patients (28.7%). Out of those who required PET-CT, 18.6% had a coronary artery calcium scoring (CACS) of more than 400, 41.8% had a CACS of zero, 29.4% had a CACS of 1-100, and 14.7% had a CACS of 100-400. Coronary angiogram was required in only 41 patients (16.1%), 12 (29.3%) required coronary interventions, 25 (61%) were treated medically, and 4 (9.8%) did not have any CAD. CT scans of pelvic arteries were performed in 118 patients (46.5%). It showed moderate or severe calcifications in only 7 patients (5.9%), whereas it was normal in 97 patients (82.2%), or it showed only mild calcifications in 14 patients (11.9%). Conclusion This study outlines the prevalence of CV risk factors and the findings of the pretransplant CV workup among KTx candidates who underwent KTx. Multicenter national studies will be helpful to validate the generalizability of these findings.
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Affiliation(s)
- Ziad Arabi
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, College of Medicine, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed H. Tawhari
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, College of Medicine, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Haneen S. Al Rajih
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, College of Medicine, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Talha M. Youssouf
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, College of Medicine, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamad Y. Abdulgadir
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, College of Medicine, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Hughes DL, Pan J, Answine AR, Sonnenday CJ, Waits SA, Kumar SS, Menees DS, Wanamaker B, Bhave NM, Tincopa MA, Fontana RJ, Sharma P. Positron emission tomography myocardial perfusion imaging (PET MPI) findings predictive of post-liver transplant major adverse cardiac events. Liver Transpl 2023; 29:970-978. [PMID: 36879556 DOI: 10.1097/lvt.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
Positron emission tomography myocardial perfusion imaging (PET MPI) is a noninvasive diagnostic test capable of detecting coronary artery disease, structural heart disease, and myocardial flow reserve (MFR). We aimed to determine the prognostic utility of PET MPI to predict post-liver transplant (LT) major adverse cardiac events (MACE). Among the 215 LT candidates that completed PET MPI between 2015 and 2020, 84 underwent LT and had 4 biomarker variables of clinical interest on pre-LT PET MPI (summed stress and difference scores, resting left ventricular ejection fraction, global MFR). Post-LT MACE were defined as acute coronary syndrome, heart failure, sustained arrhythmia, or cardiac arrest within the first 12 months post-LT. Cox regression models were constructed to determine associations between PET MPI variable/s and post-LT MACE. The median LT recipient age was 58 years, 71% were male, 49% had NAFLD, 63% reported prior smoking, 51% had hypertension, and 38% had diabetes mellitus. A total of 20 MACE occurred in 16 patients (19%) at a median of 61.5 days post-LT. One-year survival of MACE patients was significantly lower than those without MACE (54% vs. 98%, p =0.001). On multivariate analysis, reduced global MFR ≤1.38 was associated with a higher risk of MACE [HR=3.42 (1.23-9.47), p =0.019], and every % reduction in left ventricular ejection fraction was associated with an 8.6% higher risk of MACE [HR=0.92 (0.86-0.98), p =0.012]. Nearly 20% of LT recipients experienced MACE within the first 12 months of LT. Reduced global MFR and reduced resting left ventricular ejection fraction on PET MPI among LT candidates were associated with increased risk of post-LT MACE. Awareness of these PET-MPI parameters may help improve cardiac risk stratification of LT candidates if confirmed in future studies.
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Affiliation(s)
- Dempsey L Hughes
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Jason Pan
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Adeline R Answine
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Seth A Waits
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sathish S Kumar
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel S Menees
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Brett Wanamaker
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole M Bhave
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Monica A Tincopa
- Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, California
| | - Robert J Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pratima Sharma
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
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Vadalà G, Alaimo C, Buccheri G, Di Fazio L, Di Caccamo L, Sucato V, Cipriani M, Galassi AR. Screening and Management of Coronary Artery Disease in Kidney Transplant Candidates. Diagnostics (Basel) 2023; 13:2709. [PMID: 37627968 PMCID: PMC10453389 DOI: 10.3390/diagnostics13162709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients and during the first year after transplantation. For these reasons, and due to the shortage of organs available for transplant, it is of utmost importance to identify patients with a good life expectancy after transplant and minimize the transplant peri-operative risk. Various conditions, such as severe pulmonary diseases, recent myocardial infarction or stroke, and severe aorto-iliac atherosclerosis, need to be ruled out before adding a patient to the transplant waiting list. The effectiveness of systematic coronary artery disease (CAD) treatment before kidney transplant is still debated, and there is no universal screening protocol, not to mention that a nontailored screening could lead to unnecessary invasive procedures and delay or exclude some patients from transplantation. Despite the different clinical guidelines on CAD screening in kidney transplant candidates that exist, up to today, there is no worldwide universal protocol. This review summarizes the key points of cardiovascular risk assessment in renal transplant candidates and faces the role of noninvasive cardiovascular imaging tools and the impact of coronary revascularization versus best medical therapy before kidney transplant on a patient's cardiovascular outcome.
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Affiliation(s)
- Giuseppe Vadalà
- Division of Cardiology, University Hospital Paolo Giaccone, 90100 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Chiara Alaimo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Giancarlo Buccheri
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Luca Di Fazio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Leandro Di Caccamo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Vincenzo Sucato
- Division of Cardiology, University Hospital Paolo Giaccone, 90100 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Manlio Cipriani
- Institute of Transplant and Highly Specialized Therapies (ISMETT) of Palermo, 90100 Palermo, Italy;
| | - Alfredo Ruggero Galassi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
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Nielsen MB, Dahl JN, Laursen R, Jespersen B, Ivarsen P, Winther S, Birn H. In a real-life setting, risk factors, coronary artery calcium score, and coronary stenosis at computed tomography angiography are associated with major adverse cardiovascular events and all-cause mortality among kidney transplant candidates. Am J Transplant 2023; 23:1194-1208. [PMID: 37172693 DOI: 10.1016/j.ajt.2023.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
Kidney failure is associated with an increased risk of cardiovascular disease and death. This single-center, a retrospective study evaluated the association between risk factors, coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), major adverse cardiovascular events (MACEs), and all-cause mortality in kidney transplant candidates. Data on clinical risk factors, MACE, and all-cause mortality were collected from patient records. A total of 529 kidney transplant candidates were included (median follow-up of 4.7 years). CACS was evaluated in 437 patients and CTA in 411. Both the presence of ≥3 risk factors, CACS of ≥400, as well as multiple-vessel stenoses or left main artery disease predicted MACE (hazard ratio, 2.09; [95% confidence interval, 1.35-3.23]; 4.65 [2.20-9.82]; 3.70 [1.81-7.57]; 4.90 [2.40-10.01]) and all-cause mortality (harad ratio, 4.44; [95% confidence interval, 2.54-7.76]; 4.47 [2.22-9.02]; 2.82 [1.34-5.94]; 5.41 [2.81-10.41]) in univariate analyses. Among patients eligible for CACS and CTA (n = 376), only CACS and CTA were associated with both MACE and all-cause mortality. In conclusion, risk factors, CACS, and CTA provide information on the risk of MACE and mortality in kidney transplant candidates. An additional value of CACS and CTA compared with risk factors was observed for the prediction of MACE in a subpopulation undergoing both CACS and CTA.
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Affiliation(s)
- Marie Bodilsen Nielsen
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark.
| | - Jonathan Nørtoft Dahl
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Rasmus Laursen
- Department of Cardiology, Regional Hospital Central Jutland, Viborg, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Per Ivarsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Henrik Birn
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
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Alvarez-Perdomo LC, Cataño-Bedoya JU, Plaza-Tenorio M, Botero-Mora AM, Cardozo-Moreno IDP, Barrera-Lozano LM, Ramírez-Arbeláez JA, Ardila CM. Lower Extremity Peripheral Arterial Disease and Its Relationship with Adverse Outcomes in Kidney Transplant Recipients: A Retrospective Cohort Study. TRANSPLANTOLOGY 2023; 4:111-123. [DOI: 10.3390/transplantology4030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024] Open
Abstract
The purpose of the study was to characterize lower extremity peripheral arterial disease (LEPAD) in a series of kidney transplant patients and to assess the impact on adverse outcomes. A retrospective cohort study was conducted including kidney transplant recipient patients who underwent screening for LEPAD. The outcomes evaluated were classified as perioperative and post-transplant, including cardiovascular events, amputation, mortality, and loss of the graft. A total of 141 renal transplant patients screened for LEPAD were identified, with an average follow-up of 3 years. LEPAD occurred in 14.2% (20/141). No differences in cardiovascular risk factors were found between the groups, except for smoking (45% vs. 24%, p < 0.05). In the group with LEPAD, the most compromised anatomical segment was the infrapopliteus, with no iliac involvement found. The Cox proportional hazards model indicated that the variables age, gender, and weight were significant in patients with LEPAD. There were no differences between the groups in terms of graft loss and death. The infrapopliteal segment is the area of greatest stenosis in kidney transplant patients with LEPAD. Together with smoking, they can explain the presence of major amputations in kidney transplant patients; however, they had no impact on graft functionality or death.
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Affiliation(s)
| | - John Ubeimar Cataño-Bedoya
- Vascular Medicine Department, Faculty of Medicine, Universidad de Antioquia UdeA, Medellín 050010, Colombia
| | - Maribel Plaza-Tenorio
- Vascular Medicine Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia
| | - Ana María Botero-Mora
- Vascular Surgery Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia
| | | | - Luis Manuel Barrera-Lozano
- Vascular Medicine Department, Faculty of Medicine, Universidad de Antioquia UdeA, Medellín 050010, Colombia
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia
| | | | - Carlos M. Ardila
- Basic Studies Department, FdeO Universidad de Antioquia UdeA, Medellín 050010, Colombia
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Arabi Z, Tawhari MH, Rajih HSA, Youssouf TM, Abdulgadir MY. Findings of Cardiovascular Workup of Kidney Transplant Candidates: A Retrospective Study of a Single-Center in Saudi Arabia.. [DOI: 10.21203/rs.3.rs-3030184/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Background: There are limited data about the prevalence of cardiovascular (CV) risk factors and the findings of CV workup among kidney transplant (KTx) recipients (KTRs) in Saudi Arabia.
Method: A single-center retrospective study of KTRs who underwent KTx from 2017 to 2020. We reviewed the prevalence of CV risk factors and the results of the pre-KTx CV workup which was derived from the American Heart Association guidelines.
Results: We included 254 KTRs. The mean age was 43.1±15.9 years, 55.5% were men and 79.5% were living-donor KTRs. Pre-emptive KTx was 9.8%, peritoneal dialysis: 11.8% and hemodialysis: 78.3% (arteriovenous fistula: 33.1% versus hemodialysis catheter: 66.9%). Mean dialysis vintage was 4.8±3.3 years for deceased-donor KTRs versus 2.4±2.6 years for living-donor KTRs.
CV risk factors were hypertension: 76%, diabetes: 40.6% (type 1: 25.2% versus type 2: 74.7%), hyperlipemia (low-density lipoprotein> 2.6 mmol/L): 40.2%, coronary artery disease (CAD): 12.6%, smoking: 9.1%, peripheral vascular disease: 2.8%, and cerebral vascular disease: 2.4%. The prevalence of obesity stage 1 was 19.7% and obesity stage 2 was 4%.
Left ventricular hypertrophy was present in 38.5%. Ejection fraction was abnormal (<55%) in 22%. Abnormal wall motion was present in 34 patients (13.4%). Cardiac (PET-CT) stress test was indicated in 129 patients (50.8%) and showed abnormal perfusion in 37 patients (28.7%). Out of those who required PET-CT, 18.6% had coronary artery calcium scoring (CACS) more than 400, 41.8 had CACS of zero, 29.4% had CACS of 1-100, and 14.7% had CACS of 100-400.
Coronary angiogram was required in only 41 patients (16.1%), 12 (29.3%) required coronary interventions, 25 (61%) were treated medically, and 4 (9.8%) did not have any CAD.
CT scans of pelvic arteries were performed in 118 patients (46.5%). It showed moderate or severe calcifications in only 7 patients (5.9%), whereas it was normal in 97 patients (82.2%), or it showed only mild calcifications in 14 patients (11.9%).
Conclusion:
This study outlines the prevalence of CV risk factors and the findings of the pretransplant CV workup among KTx candidates who underwent KTx. Multicenter national studies will be helpful to validate the generalizability of these findings.
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Bae S, Ahn JB, Joseph C, Whisler R, Schnitzler MA, Lentine KL, Kadosh BS, Segev DL, McAdams-DeMarco MA. Statins in Kidney Transplant Recipients: Usage, All-Cause Mortality, and Interactions with Maintenance Immunosuppressive Agents. J Am Soc Nephrol 2023; 34:1069-1077. [PMID: 36890643 PMCID: PMC10278772 DOI: 10.1681/asn.0000000000000112] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/17/2023] [Indexed: 03/10/2023] Open
Abstract
SIGNIFICANCE STATEMENT Cardiovascular diseases account for 32% of deaths among kidney transplant recipients. Statin therapy is common in this population. However, its effect on mortality prevention remains unclear among kidney transplant recipients, whose clinical risk profile might be unique because of concomitant immunosuppressive therapy. In this national study of 58,264 single-kidney transplant recipients, statin use was associated with a 5% decrease in mortality. More importantly, this protective association was stronger among those who used a mammalian target of rapamycin (mTOR) inhibitor for immunosuppression (27% decrease in mTOR inhibitor users versus 5% in nonusers). Our results suggest that statin therapy may reduce mortality in kidney transplant recipients and that the strength of this protective association may vary by immunosuppression regimen. BACKGROUND Cardiovascular diseases are the leading cause of mortality in kidney transplant (KT) recipients, accounting for 32% of deaths. Statins are widely used in KT recipients, but effectiveness for preventing mortality remains unclear in this population, especially because of interaction between statins and immunosuppressive agents. We analyzed a national cohort to assess the real-world effectiveness of statins for reducing all-cause mortality in KT recipients. METHODS We studied statin use and mortality among 58,264 adults (18 years or older) who received single kidneys between 2006 and 2016 and had Medicare part A/B/D. Statin use was ascertained from Medicare prescription drug claims and deaths from Center for Medicare and Medicaid Services records. We estimated the association of statin use with mortality using multivariable Cox models, with statin use as a time-varying exposure and immunosuppression regimen as effect modifiers. RESULTS Statin use increased from 45.5% at KT to 58.2% at 1-year post-KT to 70.9% at 5-year post-KT. We observed 9785 deaths over 236,944 person-years. Overall, statin use was significantly associated with lower mortality (adjusted hazard ratio [aHR], 0.95; 95% confidence interval [CI], 0.90 to 0.99). The strength of this protective association varied by calcineurin inhibitor use (among tacrolimus users, aHR, 0.97; 95% CI, 0.92 to 1.03 versus among calcineurin nonusers, aHR, 0.72; 95% CI, 0.60 to 0.87; interaction P =0.002), mammalian target of rapamycin (mTOR) inhibitor use (among mTOR inhibitor users, aHR, 0.73; 95% CI, 0.57 to 0.92 versus among nonusers, aHR, 0.95; 95% CI, 0.91 to 1.00; interaction P =0.03), and mycophenolate use (among mycophenolate users, aHR, 0.96; 95% CI, 0.91 to 1.02 versus among nonusers, aHR, 0.76; 95% CI, 0.64 to 0.89; interaction P =0.002). CONCLUSION Real-world evidence supports statin therapy for reducing all-cause mortality in KT recipients. Effectiveness might be greater when combined with mTOR inhibitor-based immunosuppression.
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Affiliation(s)
- Sunjae Bae
- Department of Surgery, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - JiYoon B. Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Corey Joseph
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ryan Whisler
- Department of Pharmacy, Johns Hopkins Medicine, Baltimore, Maryland
| | | | - Krista L. Lentine
- Department of Internal Medicine, Saint Louis University, St. Louis, Missouri
| | - Bernard S. Kadosh
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Dorry L. Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Mara A. McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Kharawala A, Safiriyu I, Olayinka A, Hajra A, Seo J, Akunor H, Alhuarrat MAD, Tachil R. Incidence, predictors and outcomes of new onset systolic heart failure following Orthotopic liver transplant: A systematic review. Transplant Rev (Orlando) 2023; 37:100758. [PMID: 37027999 DOI: 10.1016/j.trre.2023.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND New onset Systolic heart failure (SHF), characterized by new onset left ventricular (LV) systolic dysfunction with a reduction in ejection fraction (EF) of <40%, is a common cause of morbidity and mortality among Orthotopic liver transplant (OLT) recipients. Therefore, we aimed to evaluate the prevalence, the pre-transplant predictors, and the prognostic impact of SHF post-OLT. METHODS We conducted a systematic review of the literature using electronic databases MEDLINE, Web of Science, and Embase for studies reporting acute systolic heart failure post-liver transplant from inception to August 2021. RESULT Of 2604 studies, 13 met the inclusion criteria and were included in the final systematic review. The incidence of new-onset SHF post OLT ranged from 1.2% to 14%. Race, sex, or body mass index did not significantly impact the post-OLT SHF incidence. Alcoholic liver cirrhosis, pre-transplant systolic or diastolic dysfunction, troponin, brain natriuretic peptide (BNP), blood urea nitrogen (BUN) elevation, and hyponatremia were noted to be significantly associated with the development of SHF post-OLT. The significance of MELD score in the development of post-OLT SHF is controversial. Pre-transplant beta-blocker and post-transplant tacrolimus use were associated with a lower risk of developing SHF. The average 1-year mortality rate in patients with SHF post-OLT ranged from 0.00% to 35.2%. CONCLUSION Despite low incidence, SHF post-OLT can lead to higher mortality. Further studies are required to fully understand the underlying mechanism and risk factors.
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Kopparam RV, Grady D, Redberg RF. Coronary Heart Disease Testing Before Kidney Transplant-A Call for Revised Guidance. JAMA Intern Med 2023; 183:287-288. [PMID: 36806879 DOI: 10.1001/jamainternmed.2022.6841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
| | - Deborah Grady
- Department of Medicine, University of California, San Francisco.,Deputy Editor, JAMA Internal Medicine
| | - Rita F Redberg
- Division of Cardiology, Department of Medicine, University of California, San Francisco.,Editor, JAMA Internal Medicine
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40
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Battistella S, D’Arcangelo F, Grasso M, Zanetto A, Gambato M, Germani G, Senzolo M, Russo FP, Burra P. Liver transplantation for non-alcoholic fatty liver disease: indications and post-transplant management. Clin Mol Hepatol 2023; 29:S286-S301. [PMID: 36577425 PMCID: PMC10029965 DOI: 10.3350/cmh.2022.0392] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is currently the fastest growing indication to liver transplantation (LT) in Western Countries, both for end stage liver disease and hepatocellular carcinoma. NAFLD/non-alcoholic steatohepatitis (NASH) is often expression of a systemic metabolic syndrome; therefore, NAFLD/NASH patients require a multidisciplinary approach for a proper pre-surgical evaluation, which is important to achieve a post-transplant outcome comparable to that of other indications to LT. NAFLD/NASH patients are also at higher risk of post-transplant cardiovascular events, diabetes, dyslipidemia, obesity, renal impairment and recurrent NASH. Lifestyle modifications, included diet and physical activity, are key to improve survival and quality of life after transplantation. A tailored immunosuppressive regimen may be proposed in selected patients. Development of new drugs for the treatment of recurrent NASH is awaited.
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Affiliation(s)
- Sara Battistella
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, University of Padua, Padua,
Italy
| | - Francesca D’Arcangelo
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, University of Padua, Padua,
Italy
| | - Marco Grasso
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, University of Padua, Padua,
Italy
| | - Alberto Zanetto
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, University of Padua, Padua,
Italy
| | - Martina Gambato
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, University of Padua, Padua,
Italy
| | - Giacomo Germani
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, University of Padua, Padua,
Italy
| | - Marco Senzolo
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, University of Padua, Padua,
Italy
| | - Francesco Paolo Russo
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, University of Padua, Padua,
Italy
| | - Patrizia Burra
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, University of Padua, Padua,
Italy
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Doycheva I, Izzy M, Watt KD. Cardiovascular assessment before liver transplantation. CARDIO-HEPATOLOGY 2023:309-326. [DOI: 10.1016/b978-0-12-817394-7.00005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Echocardiogram screening in pediatric dialysis and transplantation. Pediatr Nephrol 2023; 38:957-974. [PMID: 36114889 PMCID: PMC9925481 DOI: 10.1007/s00467-022-05721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
Transthoracic echocardiography is commonly used to identify structural and functional cardiac abnormalities that can be prevalent in childhood chronic kidney failure (KF). Left ventricular mass (LVM) increase is most frequently reported and may persist post-kidney transplant especially with hypertension and obesity. While systolic dysfunction is infrequently seen in childhood chronic KF, systolic strain identified by speckle tracking echocardiography has been frequently identified in dialysis and it can also persist post-transplant. Echocardiogram association with long-term outcomes has not been studied in childhood KF but there are many adult studies demonstrating associations between increased LVM, systolic dysfunction, strain, diastolic dysfunction, and cardiovascular events and mortality. There has been limited study of interventions to improve echocardiogram status. In childhood, improved blood pressure has been associated with better LVM, and conversion from hemodialysis to hemodiafiltration has been associated with better diastolic and systolic function. Whether long-term cardiac outcomes are also improved with these interventions is unclear. Echocardiography is a well-established technique, and regular use in childhood chronic KF seems justified. A case can be made to extend screening to include speckle tracking echocardiography and intradialytic studies in high-risk populations. Further longitudinal studies including these newer echocardiogram modalities, interventions, and long-term outcomes would help clarify recommendations for optimal use as a screening tool.
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Bloudíčková SR. Cardiovascular disease and kidney transplantation. VNITRNI LEKARSTVI 2023; 69:282-288. [PMID: 37827825 DOI: 10.36290/vnl.2023.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Compared to general population, patients with chronic kidney disease (CKD) exhibit high prevalence of cardiovascular disease (CVD) that increases with a stage of CKD. Traditional and non-traditional risk factors associated with CKD contribute to accelerated atherosclerosis leading to CVD. CVD represents the main cause of morbidity and mortality in CKD population. Pretransplant examination is essential to evaluate and optimize the state of cardiovascular system prior transplantation, thus to minimize risks that could have a negative impact on transplant outcome.
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Dangl M, Grant JK, Vincent L, Ebner B, Maning J, Olorunfemi O, Zablah G, Sancassani R, Colombo R. The association of pre-transplant atrial fibrillation with in-hospital outcomes in patients undergoing orthotopic liver transplantation: A propensity score matching analysis. J Card Surg 2022; 37:4762-4773. [PMID: 36403274 DOI: 10.1111/jocs.17183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 09/19/2022] [Accepted: 10/22/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In this study, we sought to evaluate the prevalence and association of pre-transplant atrial fibrillation (AF) on 30-day postoperative outcomes in patients undergoing orthotopic liver transplant (OLT). METHOD The National Inpatient Sample Database was queried from 2011 to 2017 for relevant ICD-9 and ICD-10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients who underwent OLT with AF and those without. RESULTS Among 45,357 patients who underwent OLT, women made up 35.8% of the overall population. The prevalence of AF before transplant was 2932 (6.5%) with a trend toward increasing prevalence, with an average annual change rate of 4.19%. Applying propensity score matching to control for potential confounding factors, there was no association between pre-transplant AF and in-hospital mortality in patients undergoing OLT, however there was a higher incidence of perioperative complications including: acute kidney injury, ventricular tachycardia, major bleeding, blood product transfusion, and septic shock. CONCLUSION In patients undergoing OLT, pre-transplant AF is increasing in prevalence and appears to be associated with similar in-hospital mortality but worse perioperative outcomes. Greater emphasis should be placed on AF in the preoperative cardiovascular risk stratification of patients undergoing OLT.
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Affiliation(s)
- Michael Dangl
- Department of Internal Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jelani K Grant
- Department of Medicine, Cardiovascular Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Louis Vincent
- Department of Medicine, Cardiovascular Division, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Bertrand Ebner
- Department of Medicine, Cardiovascular Division, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jennifer Maning
- Department of Medicine, Cardiovascular Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Odunayo Olorunfemi
- Department of Medicine, Cardiovascular Division, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gerardo Zablah
- Department of Medicine, Cardiovascular Division, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rhea Sancassani
- Department of Medicine, Cardiovascular Division, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rosario Colombo
- Department of Medicine, Cardiovascular Division, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
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Kelderman JR, Jolink FEJ, Benjamens S, Monroy-Gonzalez AG, Pol RA, Slart RHJA. Diagnostic accuracy of myocardial perfusion imaging in patients evaluated for kidney transplantation: A systematic review and meta-analysis. J Nucl Cardiol 2022; 29:3405-3415. [PMID: 33948891 PMCID: PMC9834355 DOI: 10.1007/s12350-021-02621-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/29/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death after kidney transplantation. Coronary artery disease (CAD) assessment is therefore mandatory in patients evaluated for transplantation. We aimed to assess the diagnostic accuracy for CAD of single-photon emission computed tomography (SPECT) compared to the standards invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) in patients evaluated for kidney transplantation. METHODS We performed a systematic literature search in PubMed, EMBASE, Web of Science, OvidSP (Medline), The Cochrane Library and Google Scholar. Studies investigating the diagnostic accuracy of myocardial perfusion imaging (MPI) SPECT in patients evaluated for kidney transplantation were retrieved. After a risk of bias assessment using QUADAS-2, a meta-analysis was conducted. RESULTS Out of 1459 records, 13 MPI SPECT studies were included in the meta-analysis with a total of 1245 MPI SPECT scans. There were no studies available with CCTA as reference. Pooled sensitivity of MPI SPECT for CAD was 0.66 (95% CI 0.53 to 0.77), pooled specificity was 0.75 (95% CI 0.63 to 0.84) and the area under the curve (AUC) was 0.76. Positive likelihood ratio was 2.50 (95% CI 1.78 to 3.51) and negative likelihood ratio was 0.41 (95% CI 0.28 to 0.61). Pooled positive predictive value was 64.9% and pooled negative predictive value was 74.1%. Significant heterogeneity existed across the included studies. CONCLUSIONS MPI SPECT had a moderate diagnostic accuracy in patients evaluated for kidney transplantation, with a high rate of false-negative findings. The use of an anatomical gold standard against a functional imaging test in the included studies is however suboptimal.
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Affiliation(s)
- Jeroen R Kelderman
- University of Groningen, Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Floris E J Jolink
- University of Groningen, Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Stan Benjamens
- University of Groningen, Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrea G Monroy-Gonzalez
- University of Groningen, Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A Pol
- University of Groningen, Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- University of Groningen, Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
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46
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Cheng XS, VanWagner LB, Costa SP, Axelrod DA, Bangalore S, Norman SP, Herzog C, Lentine KL. Emerging Evidence on Coronary Heart Disease Screening in Kidney and Liver Transplantation Candidates: A Scientific Statement From the American Heart Association: Endorsed by the American Society of Transplantation. Circulation 2022; 146:e299-e324. [PMID: 36252095 PMCID: PMC10124159 DOI: 10.1161/cir.0000000000001104] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Coronary heart disease is an important source of mortality and morbidity among kidney transplantation and liver transplantation candidates and recipients and is driven by traditional and nontraditional risk factors related to end-stage organ disease. In this scientific statement, we review evidence from the past decade related to coronary heart disease screening and management for kidney and liver transplantation candidates. Coronary heart disease screening in asymptomatic kidney and liver transplantation candidates has not been demonstrated to improve outcomes but is common in practice. Risk stratification algorithms based on the presence or absence of clinical risk factors and physical performance have been proposed, but a high proportion of candidates still meet criteria for screening tests. We suggest new approaches to pretransplantation evaluation grounded on the presence or absence of known coronary heart disease and cardiac symptoms and emphasize multidisciplinary engagement, including involvement of a dedicated cardiologist. Noninvasive functional screening methods such as stress echocardiography and myocardial perfusion scintigraphy have limited accuracy, and newer noninvasive modalities, especially cardiac computed tomography-based tests, are promising alternatives. Emerging evidence such as results of the 2020 International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease trial emphasizes the vital importance of guideline-directed medical therapy in managing diagnosed coronary heart disease and further questions the value of revascularization among asymptomatic kidney transplantation candidates. Optimizing strategies to disseminate and implement best practices for medical management in the broader end-stage organ disease population should be prioritized to improve cardiovascular outcomes in these populations.
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Affiliation(s)
| | | | | | | | | | | | - Charles Herzog
- Hennepin Healthcare/University of Minnesota, Minneapolis, MN
| | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
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Kim KS, Belley-Côté E, Whitlock RP. What is the optimal prosthetic valve in dialysis? Eur Heart J 2022; 43:4657-4659. [PMID: 35866297 DOI: 10.1093/eurheartj/ehac396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Kevin S Kim
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Canada.,Population Health Research Institute, Hamilton, Canada
| | - Emilie Belley-Côté
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Canada.,Population Health Research Institute, Hamilton, Canada.,Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Richard P Whitlock
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Canada.,Population Health Research Institute, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Canada.,David Braley Cardiac, Vascular and Stroke Research Institute, Room 1C1-5B, 237 Barton St. E., Hamilton, ON, Canada L8L 2X2
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48
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Lim WH, Chew NW, Quek J, Ng CH, Tan DJH, Xiao J, Nah B, Lee GH, Huang DQ, Tan EXX, Muthiah MD. Echocardiographic assessment of cardiovascular function and clinical outcomes in liver transplant recipients. Clin Transplant 2022; 36:e14793. [PMID: 35962725 DOI: 10.1111/ctr.14793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/27/2022] [Accepted: 08/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Cardiovascular disease contributes to a high rate of morbidity and mortality after liver transplantation (LT). However, the progression of cardiac function and cardiac remodeling in LT recipients remains poorly understood. This study sought to evaluate the progression of cardiac function and structure in LT recipients and identify independent predictors of prognosis using echocardiography. METHODS From 2009 to 2019, 178 adult LT recipients at a tertiary academic transplant center were retrospectively studied. Transthoracic echocardiograms 1-year pre- and post-LT were assessed. Primary outcomes were progression of systolic and diastolic function. Secondary outcomes included left ventricular remodeling, all-cause mortality, and heart failure readmission post-LT. Subgroup analyzes were performed for etiology of native liver disease. A multivariable model was constructed to examine independent predictors of outcomes. RESULTS Systolic function significantly worsened, with reduction in stroke volume (45-37 ml/m2 , p < .001), left ventricular ejection fraction (LVEF) (65%-62%, p < .001) and cardiac index (3.00-2.60 L/min/m2 , p < .001). Conversely, there were significant improvements in diastolic indices, including tricuspid regurgitation Vmax (228-215 cm/s, p = .017), left atrial volume index (LAVI) (32-26 ml/m2 , p < .001) and right ventricular systolic pressure (RVSP) (31-28 mmHg, p = .001). Additionally, patients had increased relative wall thickness (RWT) (p < .001) and decreased left ventricular end-diastolic dimension/body surface area (p < .001) post-LT. The independent predictors for all-cause mortality and heart failure were increased pre-LT mitral annular early diastolic velocity (HR 1.11, CI 1.02-1.22, p = .018), LAVI (HR 1.06, CI 1.02-1.11, p = .007) and decreased LVEF (HR .89, CI .82-.97, p = .006). The effect of non-alcoholic steatohepatitis on cardiovascular outcomes post-LT was largely comparable to that of Hepatitis B. CONCLUSION This study showed reduced systolic and improved diastolic function in LT recipients and highlighted the utility of pre-LT echocardiogram in the prognostication and risk stratification of LT candidates.
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Affiliation(s)
- Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Ws Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Nah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Guan Huei Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Eunice Xiang Xuan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
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Kwon HM, Kim JH, Yang JW, Hwang GS. Temporary postoperative myocardial injury and long-term survival in liver transplant patients with coronary artery disease. Anesth Pain Med (Seoul) 2022; 17:404-411. [DOI: 10.17085/apm.22167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Coronary artery disease (CAD) is increasing worldwide due to the aging population and cardiometabolic syndrome. However, the extent of postoperative myocardial injury, the most common cause of death during the 30 days after noncardiac surgery, remains unclear with respect to liver transplant (LT) patients with CAD. We examined the link between post-LT high sensitivity cardiac troponin I (hs_cTnI) and long-term survival according to liver disease severity.Methods: Consecutive patients who underwent LT (n = 3,220) from 2010 to 2020 were evaluated retrospectively. CAD was defined as a history of coronary artery bypass surgery or percutaneous intervention, or previous myocardial infarction. Peak hs_cTnI levels within 30 days post-transplant were compared in patients with and without CAD. The primary endpoint was defined as an all-cause mortality at 12 years following LT. Secondary endpoints include peak hs_cTnI level within post-transplant 30 days and 30-day mortality. Survival analysis was performed using the Kaplan–Meier method.Results: CAD patients (n = 264, 8.2%) had higher peak hs_cTnI levels within 30 days post-LT than those without CAD (median [interquartile]: 0.068 [0.030–0.154] vs. 0.087 [0.037–0.203] ng/ml, respectively; P = 0.004); however, the mortality rate was comparable (14.7% vs. 14.8%, respectively, P = 0.999), at 12 years, and 1.9% vs. 1.1% (P = 0.522) at 30 days, respectively, at 30 days. Subgroup analysis with stratified liver disease severity identified a similar risk of long-term mortality.Conclusions: Although the peak hs_cTnI level within 30 days was higher in revascularized or treated CAD patients after LT compared those without CAD, long-term mortality rates at 12 years and 30-day mortality rate were comparable.
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50
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Kwon HM, Kim JH, Kim JY, Hwang GS. Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failure. Anesth Pain Med (Seoul) 2022; 17:412-419. [DOI: 10.17085/apm.22168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Patients with acute-on-chronic liver failure (ACLF) are critically ill and have high waiting-list mortality. Although studies demonstrated that appropriately treated coronary artery disease (CAD) should not be regarded as a contraindication to liver transplant (LT), data regarding long-term outcomes in critically ill liver LT recipients are lacking. The aim of this study was to compare the rates of all-cause death at 5 years following LT in patients with ACLF with or without CAD.Methods: Between 2010 and 2020, we evaluated 921 consecutive LT patients (MELD score, 32 ± 9) and ACLF classified by CLIF-C ACLF score. Up to 5-year all-cause death according to the CAD status was examined. CAD was defined as a preoperative history of coronary artery bypass graft or a percutaneous intervention and old myocardial infarction. Kaplan-Meier survival analysis was used.Results: Up to 5 years, 212 (23.0%) of all ACLF patients (n = 921) in whom 17 (29.3%) of 58 CAD patients died. In patients with CAD (6.3%, 58/921), the Kaplan-Meier cumulative mortality rate at 5 years was numerically higher but was not statistically significant when compared with those without CAD (32.9% vs. 23.5%, log-rank, P = 0.25). In subgr oup analysis, there were comparable risks of cumulative mortalities at 5 years across the stratification of ACLF grade 1, 2, and 3 (log-rank P = 0.062, P = 0.72, and P = 0.999, respectively).Conclusions: All-cause mortality is high in patients with ACLF after LT but is not related to the presence of revascularized or treated CAD, across the stratification of ACLF grades.
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