Routine testing for coronary heart disease (CHD) before kidney transplantation does not reduce the risk for early post-transplant myocardial infarction or death, a new study finds.
Among 79,334 adult first-time kidney transplant recipients during 2012 to 2014 in the US Renal Data System, 4604 (5.8%) experienced the primary composite outcome of death or acute myocardial infarction within 30 days of transplantation.
Varying proportions of patients underwent nonurgent CHD testing (invasive or noninvasive) during the 12 months before kidney transplantation. Examples of testing included stress electrocardiogram or echocardiogram or coronary angiography. During the most recent era studied, 2012-2014, the pretransplant CHD testing rate was 56% vs 24% among transplant programs in the top and bottom quintiles of testing intensity, respectively. Investigators observed similar testing patterns in the earlier eras.
Analyses revealed that pretransplant CHD testing did not significantly reduce the rate of the primary outcome during 2012-2014, 2008-2011, or 2004-2007, Xingxing S. Cheng, MD, MS, of Stanford University School of Medicine in Palo Alto, California, and colleagues reported in JAMA Internal Medicine. In 2000-2003, the investigators found a slight increase in the primary outcome with CHD testing. The finding might be attributable to use of bare metal stents. The FDA approved the first drug-eluting stent in 2003.
Some members of the nephrology and transplant community have suggested de-escalating CHD screening in asymptomatic kidney transplant candidates. In a JAMA interview, Dr Cheng supported risk stratification.
“The study findings potentially challenge the ubiquity of CHD testing before kidney transplant and should be confirmed in interventional studies,” according Dr Cheng’s team.
The ISCHEMIA-CKD trial similarly found that invasive CHD testing involving coronary angiography followed by revascularization did not benefit asymptomatic patients with advanced chronic kidney disease and stable coronary heart disease.
Cheng XS, Liu S, Han J, Stedman MR, Baiocchi M, Tan JC, Chertow GM, Fearon WF. Association of pretransplant coronary heart disease testing with early kidney transplant outcomes. JAMA Intern Med. Published online January 3, 2023. doi:10.1001/jamainternmed.2022.6069
Association of pretransplant coronary heart disease testing with early kidney transplant outcomes. JAMA Internal Medicine; January 3, 2023.