To further investigate this, Dr. Klein’s group performed in a separate analysis of patients receiving standard criteria donor kidneys. The investigators found that, in contrast to findings in the ECD group, PCD patients with a history of revascularization had a markedly increased risk of overall and cardiovascular death following transplantation. The analysis included 731 transplant recipients, of whom 403 (55%) had PCD and 328 did not. A total of 93 (23%) underwent revascularization prior to transplantation.

Among the PCD patients, the estimated five-year survival was 53% for those underwent revascularization compared with 88% for those who did not. The researchers observed no significant difference in estimated five-year survival between PCD patients without revascularization and patients with no history of cardiac disease (89%).

Fatal cardiovascular events accounted for 35.7% of deaths among the revascularized patients, 23.5% of deaths among PCD patients without revascularization, and 15.4% of deaths among patients without a cardiac disease history.

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Summarizing the findings for the entire group of deceased donor recipients, the use of an ECD kidney was associated with markedly increased overall and cardiovascular mortality as well as decreased death-censored graft survival, whereas recipient history of pre-transplant revascularization was associated only with decreased patient survival.

Transplant recipients with a history of pre-transplant coronary revascularization, however, had similar overall and cardiovascular death rates whether they received an ECD versus SCD kidney, illustrating the non-additive effects of these donor and recipient factors, Dr. Klein said.