CME Article Review Article
Cardiac imaging for the assessment of patients being evaluated for kidney or liver transplantation

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Abstract

Cardiac risk assessment prior to kidney and liver transplantation is controversial. Given the paucity of available organs, selecting appropriate recipients with favorable short- and long-term cardiovascular risk profile is crucial. Using noninvasive cardiac imaging tools to guide cardiovascular risk assessment and management can also be challenging and controversial. In this article, we address the burden of coronary artery disease among kidney and liver transplant candidates and review the literature pertaining to the diagnostic accuracy and the prognostic value of noninvasive cardiac imaging techniques in this population.

Introduction

Cardiac risk assessment prior to liver and kidney transplantation is controversial. Due to the paucity of available organs, the selection of appropriate recipients with an acceptable post-operative and long-term cardiovascular risk profile is critical. The general perioperative cardiovascular evaluation guidelines and the appropriate use criteria are not applicable in, or intended for, this special population.1,2 The American Heart Association (AHA) and American College of Cardiology (ACC) have recently addressed the evaluation and management of cardiac disease in this population in a comprehensive consensus statement, endorsed by the American Society of Transplant Surgeons, the American Society of Transplantation, and the National Kidney Foundation.3 In this review, we will discuss coronary artery disease (CAD) burden in patients undergoing kidney and liver transplantation evaluation and expound on the use of cardiac imaging in the assessment of CAD in this population within the context of the recent AHA/ACC consensus statement.

Section snippets

Kidney Transplantation

In 2011, more than 17,000 kidney transplantations were performed in the United States. There are currently more than 100,000 patients listed for kidney transplantation with a median waiting time of 2.6 years.4 It is established that a successful kidney transplant improves the quality of life and reduces the mortality risk when compared with maintenance dialysis.5 Although transplantation confers the highest survival benefit among all the different renal replacement therapies, renal allograft

Liver Transplant

There are currently 17,000 patients on the liver transplant waiting list. Although the number of donors has remained constant, the number of liver transplant candidates in the United States continues to rise annually, leading to longer pre-transplant wait time and older recipient age.49 Given the scarcity of donors and the significant cost involved, selecting patients with acceptable short- and long-term cardiovascular risk profiles is paramount. Cardiovascular evaluation in orthotopic liver

Disclosures

Rami Doukky received research support from Astellas Pharma U.S. and served on the Advisory Board of Astellas Pharma U.S. Other authors have no conflicts.

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