CME Article Review ArticleCardiac imaging for the assessment of patients being evaluated for kidney or liver transplantation
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.
References (100)
- et al.
ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery
J Am Coll Cardiol
(2007) - et al.
ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. Endorsed by the American College of Emergency Physicians
J Am Coll Cardiol
(2009) - et al.
Cardiac disease evaluation and management among kidney and liver transplantation candidates: A scientific statement from the American Heart Association and the American College of Cardiology Foundation
J Am Coll Cardiol
(2012) - et al.
Long-term survival in renal transplant recipients with graft function
Kidney Int
(2000) - et al.
Predicting coronary heart disease in renal transplant recipients: A prospective study
Kidney Int
(2004) - et al.
Cardiovascular risk and renal transplantation: Post hoc analyses of the Assessment of Lescol in Renal Transplantation (ALERT) Study
Am J Kidney Dis
(2005) - et al.
Predictors of survival in patients with end-stage renal disease evaluated for kidney transplantation
Am J Cardiol
(2007) - et al.
Safety of regadenoson in patients with end-stage renal disease
Am J Cardiol
(2010) - et al.
The safety and tolerability of regadenoson in patients with end-stage renal disease: The first prospective evaluation
J Nucl Cardiol
(2013) - et al.
Attenuation of the side effect profile of regadenoson: A randomized double-blinded placebo-controlled study with aminophylline in patients undergoing myocardial perfusion imaging. “The ASSUAGE trial”
J Nucl Cardiol
(2012)
Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): A prospective trial
Lancet
Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease
J Am Coll Cardiol
Does rubidium-82 PET have superior accuracy to SPECT perfusion imaging for the diagnosis of obstructive coronary disease? A systematic review and meta-analysis
J Am Coll Cardiol
Coronary artery calcification measured with electron-beam computerized tomography correlates poorly with coronary artery angiography in dialysis patients
Am J Kidney Dis
Coronary artery calcification and aortic pulse wave velocity in chronic kidney disease patients
Kidney Int
Technetium myocardial perfusion scanning in prerenal transplant evaluation in the United Kingdom
Transplant Proc
Prognostic value of myocardial perfusion imaging in predicting outcome after renal transplantation
Am J Cardiol
Coronary vascular dysfunction and prognosis in patients with chronic kidney disease
JACC Cardiovasc Imaging
Prognostic value of dobutamine stress echocardiography in patients with chronic kidney disease
Am Heart J
Stress echocardiography for risk stratification in patients with end-stage renal disease undergoing renal transplantation
J Am Soc Echocardiogr
Clinical and pathologic risk factors for atherosclerosis in cirrhosis: A comparison between NASH-related cirrhosis and cirrhosis due to other aetiologies
J Hepatol
Influence of coronary artery disease on outcomes after liver transplantation
Transplant Proc
Cardiovascular risk assessment of the liver transplant candidate
J Am Coll Cardiol
Predictive value of stress myocardial perfusion imaging in liver transplant candidates
Am J Cardiol
Safety of regadenoson in patients with end-stage liver disease
J Nucl Cardiol
Accuracy of stress myocardial perfusion imaging to diagnose coronary artery disease in end stage liver disease patients
Am J Cardiol
Value of stress myocardial perfusion scanning in diagnosis of severe coronary artery disease in liver transplantation candidates
Transplant Proc
Comparison of technetium-99m tetrofosmin and thallium-201 single-photon emission computed tomographic imaging for detection of myocardial perfusion defects in patients with coronary artery disease
J Am Coll Cardiol
Predictive value of dobutamine stress echocardiography for coronary artery disease detection in liver transplant candidates
Am J Transplant
Comparison of the frequency of coronary artery disease in alcohol-related versus non-alcohol-related endstage liver disease
Am J Cardiol
The role of coronary calcium score in the risk assessment of liver transplant candidates
Transplant Proc
Coronary computer tomographic angiography for preoperative risk stratification in patients undergoing liver transplantation
Eur J Radiol
Clinical value of preoperative coronary risk assessment by computed tomographic arteriography prior to adult living donor liver transplantation
Transplant Proc
Usefulness of preoperative stress perfusion imaging in predicting prognosis after liver transplantation
Am J Cardiol
Screening stress myocardial perfusion imaging and eligibility for liver transplantation
Am J Cardiol
Preoperative dobutamine stress echocardiography, intraoperative events, and intraoperative myocardial injury in liver transplantation
Transplant Proc
Usefulness of tachycardic-stress perfusion imaging to predict coronary artery disease in high-risk patients with chronic renal failure
Am J Cardiol
Informational contribution of noninvasive screening tests for coronary artery disease in patients on chronic renal replacement therapy
Am J Kidney Dis
Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients
Kidney Int
A preoperative echocardiographic predictive model for assessment of cardiovascular outcome after renal transplantation
J Am Soc Echocardiogr
Dobutamine stress echocardiography for the detection of significant coronary artery disease in renal transplant candidates
Am J Kidney Dis
COmparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients
J Am Med Assoc
Patient survival after renal transplantation; more than 25 years follow-up
Nephrol Dial Transplant
Cardiac survival after pre-emptive coronary angiography in transplant patients and those awaiting transplantation
Clin J Am Soc Nephrol
Screening for significant coronary artery disease in high-risk renal transplant candidates
Coron Artery Dis
Cardiovascular disease in stable renal transplant patients in Norway: Morbidity and mortality during a 5-yr follow-up
Clin Transplant
Electrocardiographic left ventricular hypertrophy in renal transplant recipients: Prognostic value and impact of blood pressure and anemia
J Am Soc Nephrol
The evaluation of renal transplantation candidates: Clinical practice guidelines
Am J Transplant
A report of the Lisbon Conference on the care of the kidney transplant recipient
Transplantation
Cited by (32)
Impact of change of ischemic burden on the outcomes of ESRD patients awaiting kidney transplantation
2023, Journal of Nuclear CardiologyDiagnostic Yield of Coronary Angiography in Asymptomatic Orthotopic Liver Transplantation Candidates
2022, Cardiovascular Revascularization MedicineReview of cardiovascular imaging in the Journal of Nuclear Cardiology in 2017. Part 2 of 2: Myocardial perfusion imaging
2018, Journal of Nuclear CardiologyThe prognostic and diagnostic implications of surveillance serial myocardial perfusion imaging in asymptomatic renal transplant candidates
2023, Journal of Nuclear Cardiology
See related editorial, doi:10.1007/s12350-014-0006-2.