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• W3096398575 abstract "Screening for asymptomatic coronary artery disease prior to kidney transplantation aims to reduce peri- and post-operative cardiac events. It is uncertain if this is achieved. Here, we investigated whether pre-transplant screening with a stress test or coronary angiogram associated with any difference in major adverse cardiac events (MACE) up to five years post-transplantation. We examined a national prospective cohort recruited to the Access to Transplant and Transplant Outcome Measures study who received a kidney transplant between 2011-2017, and linked patient demographics and details of cardiac screening investigations to outcome data extracted from the Hospital Episode Statistics dataset and United Kingdom Renal Registry. Propensity score matched groups were analyzed using Kaplan-Meier and Cox survival analyses. Overall, 2572 individuals were transplanted in 18 centers; 51% underwent screening and the proportion undergoing screening by center ranged from 5-100%. The incidence of MACE at 90 days, one and five years was 0.9%, 2.1% and 9.4% respectively. After propensity score matching based on the presence or absence of screening, 1760 individuals were examined (880 each in screened and unscreened groups). There was no statistically significant association between screening and MACE at 90 days (hazard ratio 0.80, 95% Confidence Interval 0.31-2.05), one year (1.12, 0.51–2.47) or five years (1.31, 0.86-1.99). Age, male sex and history of ischemic heart disease were associated with MACE. Thus, there is no association between screening for asymptomatic coronary artery disease and MACE up to five years post-transplant. Practices involving unselected screening of transplant recipients should be reviewed. Screening for asymptomatic coronary artery disease prior to kidney transplantation aims to reduce peri- and post-operative cardiac events. It is uncertain if this is achieved. Here, we investigated whether pre-transplant screening with a stress test or coronary angiogram associated with any difference in major adverse cardiac events (MACE) up to five years post-transplantation. We examined a national prospective cohort recruited to the Access to Transplant and Transplant Outcome Measures study who received a kidney transplant between 2011-2017, and linked patient demographics and details of cardiac screening investigations to outcome data extracted from the Hospital Episode Statistics dataset and United Kingdom Renal Registry. Propensity score matched groups were analyzed using Kaplan-Meier and Cox survival analyses. Overall, 2572 individuals were transplanted in 18 centers; 51% underwent screening and the proportion undergoing screening by center ranged from 5-100%. The incidence of MACE at 90 days, one and five years was 0.9%, 2.1% and 9.4% respectively. After propensity score matching based on the presence or absence of screening, 1760 individuals were examined (880 each in screened and unscreened groups). There was no statistically significant association between screening and MACE at 90 days (hazard ratio 0.80, 95% Confidence Interval 0.31-2.05), one year (1.12, 0.51–2.47) or five years (1.31, 0.86-1.99). Age, male sex and history of ischemic heart disease were associated with MACE. Thus, there is no association between screening for asymptomatic coronary artery disease and MACE up to five years post-transplant. Practices involving unselected screening of transplant recipients should be reviewed. Cardiac screening prior to renal transplantation—good intentions, rather than good evidence, dictate practiceKidney InternationalVol. 99Issue 2PreviewCardiovascular disease is the leading cause of death in kidney transplant recipients in many transplant registries. An analysis of transplant recipients from the United Kingdom using propensity score matching (PSM) suggests there are limited or no benefits to cardiovascular screening before transplant listing. We suggest that short of a randomized controlled trial (RCT) in this area, these data are sufficient to suggest that transplant centers should reflect on their current protocols for cardiovascular workup required before transplantation. Full-Text PDF The authors replyKidney InternationalVol. 99Issue 3PreviewThank you to Ducloux et al.1 for their comments on our study2 and the opportunity to respond. We address their concerns in order here. Full-Text PDF Pretransplant coronary artery disease screening is still validKidney InternationalVol. 99Issue 3PreviewNimmo et al.1 reported the results of a study suggesting that screening for asymptomatic coronary artery disease (CAD) does not predict cardiac events in kidney transplant recipients. We disagree with their conclusions. Full-Text PDF" @default.
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• W3096398575 date "2021-02-01" @default.
• W3096398575 modified "2023-10-11" @default.
• W3096398575 title "A propensity score–matched analysis indicates screening for asymptomatic coronary artery disease does not predict cardiac events in kidney transplant recipients" @default.
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• W3096398575 doi "https://doi.org/10.1016/j.kint.2020.10.019" @default.
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