BOSTON—Recipients of expanded criteria donor (ECD) kidneys have similar patient and graft survival regardless of their pre-transplant history of cardiac disease, including coronary revascularization prior to transplantation, a study shows.
The findings suggest that the use of ECD kidneys in ESRD patients with a history of pre-transplant cardiac disease—whether or not treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)—may be appropriate, said lead investigator Christina Klein, MD, a transplant fellow at the University of Wisconsin in Madison. She presented study findings here at the American Transplant Congress.
She and her colleagues studied 272 patients who received ECD kidneys. Of the 182 (67%) patients who had pre-transplant cardiac disease, 63 (34.6%) had a history of coronary revascularization, and 119 (65.4%) did not. The remaining 90 patients (33%) had no pre-transplant cardiac disease (PCD).
The estimated five-year patient survival was 53% and 68% for the revascularization and no revascularization groups, respectively, and 64% for the patients without a history of cardiac disease. In addition, fatal cardiovascular events accounted for 33%, 25%, and 37.5% of deaths with a functioning graft. The five-year, death-censored graft survival was 66%, 57%, and 71%, respectively. None of the differences among the groups was statistically significant.
As to why the cardiovascular death rate was not lower in patients with pre-transplant revascularization, Dr. Klein explained that although PCI or CABG can restore blood flow in blocked coronary arteries, fatal cardiovascular events can be due to a wide variety of problems that revascularization cannot prevent. More importantly, she said, all recipients of ECD kidneys had increased overall and cardiovascular mortality independent of documented pre-transplant coronary artery disease.