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Siddiqui MU, Junarta J, Marhefka GD. Coronary Revascularization Versus Optimal Medical Therapy in Renal Transplant Candidates With Coronary Artery Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e023548. [PMID: 35132876 PMCID: PMC9245820 DOI: 10.1161/jaha.121.023548] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Coronary artery disease (CAD) is highly prevalent in patients with chronic kidney disease and is a common cause of mortality in end‐stage renal disease. Thus, patients with end‐stage renal disease are routinely screened for CAD before renal transplantation. The usefulness of revascularization before transplantation remains unclear. We hypothesize that there is no difference in all‐cause and cardiovascular mortality in waitlisted renal transplant candidates with CAD who underwent revascularization versus those treated with optimal medical therapy before transplantation. Methods and Results This meta‐analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta‐Analyses guidelines. MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Risk of bias was assessed using the modified Newcastle‐Ottawa Scale and Cochrane risk of bias tool. The primary outcome of interest was all‐cause mortality. Eight studies comprising 945 patients were included (36% women, mean age 56 years). There was no difference in all‐cause mortality (risk ratio [RR], 1.16 [95% CI, 0.63–2.12), cardiovascular mortality (RR, 0.75 [95% CI, 0.29–1.89]), or major adverse cardiovascular events (RR, 0.78 [95% CI, 0.30–2.07]) when comparing renal transplant candidates with CAD who underwent revascularization versus those who were on optimal medical therapy before renal transplant. Conclusions This meta‐analysis demonstrates that revascularization is not superior to optimal medical therapy in reducing all‐cause mortality, cardiovascular mortality, or major adverse cardiovascular events in waitlisted kidney transplant candidates with CAD who eventually underwent kidney transplantation.
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Affiliation(s)
- Muhammad U Siddiqui
- Department of Medicine Thomas Jefferson University Hospitals Philadelphia PA
| | - Joey Junarta
- Department of Medicine Thomas Jefferson University Hospitals Philadelphia PA
| | - Gregary D Marhefka
- Jefferson Heart Institute Thomas Jefferson University Hospitals Philadelphia PA
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2
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Good Long-term Results Following Simultaneous Pancreas-kidney Transplantation in a 69-y-old Recipient: A Case Report. Transplant Direct 2021; 7:e773. [PMID: 34646936 PMCID: PMC8500590 DOI: 10.1097/txd.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
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3
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Wong WS, McKay G, Stevens KI. Diabetic kidney disease and transplantation options. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Wan S Wong
- Renal and Transplant Unit Queen Elizabeth University Hospital Glasgow UK
| | - Gerard McKay
- Department of Diabetes, Endocrinology and Clinical Pharmacology, Glasgow Royal Infirmary Glasgow UK
| | - Kathryn I Stevens
- Renal and Transplant Unit Queen Elizabeth University Hospital Glasgow UK
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Hau HM, Jahn N, Brunotte M, Wagner T, Rademacher S, Branzan D, Sucher E, Seehofer D, Sucher R. Pre-operative ankle-brachial index for cardiovascular risk assessment in simultaneous pancreas-kidney transplant recipients: a simple and elegant strategy! BMC Surg 2021; 21:156. [PMID: 33752640 PMCID: PMC7983212 DOI: 10.1186/s12893-021-01159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. We aimed to investigate the feasibility of preoperative screening for peripheral arterial disease (PAD), specifically ankle-brachial index (ABI) testing, to predict peri- and postoperative outcomes in SPKT recipients. Methods Medical data (2000–2016) from all patients with IDDM and ESKD undergoing SPKT at our transplant center were retrospectively analyzed. The correlation between PAD (defined by an abnormal ABI before SPKT and graft failure and mortality rates as primary end points, and the occurrence of acute myocardial infarction, cerebrovascular and peripheral vascular complications as secondary end points were investigated after adjustment for known cardiovascular risk factors. Results Among 101 SPKT recipients in our transplant population who underwent structured physiological arterial studies, 17 patients (17%) were diagnosed with PAD before transplantation. PAD, as defined by a low ABI index, was an independent and significant predictor of death (HR, 2.99 (95% CI 1.00–8.87), p = 0.049) and pancreas graft failure (HR, 4.3 (95% CI 1.24–14.91), p = 0.022). No significant differences were observed for kidney graft failure (HR 1.85 (95% CI 0.76–4.50), p = 0.178). In terms of the secondary outcomes, patients with PAD were more likely to have myocardial infarction, stroke, limb ischemia, gangrene or amputation (HR, 2.90 (95% CI 1.19–7.04), p = 0.019). Conclusions Pre-transplant screening for PAD and cardiovascular risk factors with non-invasive ABI testing may help to reduce perioperative complications in high-risk patients. Future research on long-term outcomes might provide more in depth insights in optimal treatment strategies for PAD among SPKT recipients.
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Affiliation(s)
- Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany. .,Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,Department of Surgery, University Hospital of Dresden, Fetscherstrasse 74, 03107, Dresden, Germany.
| | - Nora Jahn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Max Brunotte
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Tristan Wagner
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Daniela Branzan
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
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Messner F, Leemkuil M, Yu Y, Massie AB, Krendl FJ, Benjamens S, Bösmüller C, Weissenbacher A, Schneeberger S, Pol RA, Margreiter C. Recipient age and outcome after pancreas transplantation: a retrospective dual-center analysis. Transpl Int 2021; 34:657-668. [PMID: 33570795 PMCID: PMC8049064 DOI: 10.1111/tri.13845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 02/08/2021] [Indexed: 01/16/2023]
Abstract
With a later onset of diabetes complications and thus increasing age of transplant candidates, many centers have extended upper age limits for pancreas transplantation. This study investigates the effect of recipient and donor age on outcomes after pancreas transplantation.We retrospectively analyzed 565 pancreas transplants performed at two Eurotransplant centers. The cohort was split at a recipient and donor age of 50 and 40 years, respectively. Median recipient age in old patients (≥50 years; 27.2%) was 54 years and 40 years in young patients (<50 years). Compared to young recipients, old recipients had an inferior patient survival rate (≥50: 5yr, 82.8%; 10yr, 65.6%; <50: 5yr, 93.3%; 10yr, 82.0%; P < 0.0001). Old recipients demonstrated comparable death-censored pancreas (≥50: 1yr, 80.6%; 5yr, 70.2%; <50: 1yr, 87.3%; 5yr, 77.8%; P = 0.35) and kidney graft survival (≥50: 1yr, 97.4%; 5yr, 90.6%; <50: 1yr, 97.8%; 5yr, 90.2%; P = 0.53) compared to young recipients. Besides a lower rate of kidney rejection, similar relative risks for postoperative complications were detected in old and young patients. This study shows that despite an increased mortality in old recipients, excellent graft survival can be achieved similar to that of young patients. Age alone should not exclude patients from receiving a pancreas transplant.
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Affiliation(s)
- Franka Messner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Marjolein Leemkuil
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Yifan Yu
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allan B Massie
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Felix J Krendl
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Stan Benjamens
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Claudia Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert A Pol
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Christian Margreiter
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Dogan U, Yaprak M, Dogan EA, Onac M, Yılmaz VT, Aydinli B. Cardiovascular and Neurologic Complications in Kidney Transplant Recipients: A Focused Appraisal of Symptoms. Transplant Proc 2019; 51:1101-1107. [PMID: 31101180 DOI: 10.1016/j.transproceed.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 01/27/2019] [Accepted: 02/03/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVE After a kidney transplantation, all efforts are focused on graft function. However, cardiovascular and neurologic complications might lead to decreased quality of life and shortened life expectancy. Early recognition of related symptoms might be critical to successfully manage these complications. METHODS AND PATIENTS We retrospectively reviewed the medical records of patients who had undergone kidney transplantation in a tertiary center between January 2014 and December 2017. Demographic data and past medical history were systematically gathered. Symptoms related to cardiac or neurologic disorders and final diagnoses were recorded. RESULTS One hundred eighty-six patients were evaluated by a cardiologist or a neurologist in the early post-operative period or long-term follow-up. Chest pain (n = 17; 9.1%) and palpitations (n = 13; 7.0%) were the most prevalent symptoms. Coronary artery disease was diagnosed in 70.6% (n = 12) of the patients presenting with chest pain. All of the patients were treated successfully, with either antianginal drugs or percutaneous angioplasty. Atrial fibrillation was diagnosed in 53.9% (n = 7) of the patients presenting with palpitations. Headache was the most prevalent chronic neurologic symptom (n = 16; 8.6%). Transient ischemic attack occured in 7 patients (3.8%) and 5 (2.7%) patients experienced ischemic stroke. CONCLUSION Kidney transplantation is associated with short- and long-term cardiac and neurologic complications. Our findings underscore the crucial role of questioning symptoms that might be related to severe disorders. Asymptomatic patients with high risk factors must also be under scope. Attending physicians should have a low threshold for referring these patients to cardiologists and neurologists.
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Affiliation(s)
- U Dogan
- Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
| | - M Yaprak
- Department of General Surgery, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - E A Dogan
- Department of Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - M Onac
- Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - V T Yılmaz
- Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - B Aydinli
- Department of General Surgery, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Knapper JT, Raval Z, Harinstein ME, Friedewald JJ, Skaro AI, Abecassis MI, Ali ZA, Gheorghiade M, Flaherty JD. Assessment and management of coronary artery disease in kidney and pancreas transplant candidates. J Cardiovasc Med (Hagerstown) 2019; 20:51-58. [DOI: 10.2459/jcm.0000000000000742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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Gasteiger S, Cardini B, Göbel G, Oberhuber R, Messner F, Resch T, Bösmüller C, Margreiter C, Schneeberger S, Maglione M. Outcomes of pancreas retransplantation in patients with pancreas graft failure. Br J Surg 2018; 105:1816-1824. [PMID: 30007018 PMCID: PMC6282534 DOI: 10.1002/bjs.10929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/17/2018] [Accepted: 06/01/2018] [Indexed: 12/23/2022]
Abstract
Background Pancreas retransplantation is still a controversial option after loss of a pancreatic graft. This article describes the experience of pancreas retransplantation at a high‐volume centre. Methods This was a retrospective observational study of all pancreas retransplantations performed in a single centre between 1997 and 2013. Pancreatic graft loss was defined by the return to insulin dependence. Risk factors for graft loss as well as patient and graft survival were analysed using logistic and time‐to‐event regression models. Results Of 409 pancreas transplantations undertaken, 52 (12·7 per cent) were identified as pancreas retransplantations. After a median follow‐up of 65·0 (range 0·8–174·3) months, 1‐ and 5‐year graft survival rates were 79 and 69 per cent respectively, and 1‐ and 5‐year patient survival rates were 96 and 89 per cent. During the entire follow‐up, 22 grafts (42 per cent) were lost. Patient survival was not associated with any of the donor‐ or recipient‐related factors investigated. Five‐year graft survival was better after simultaneous kidney–pancreas retransplantation than pancreas retransplantation alone: 80 per cent (16 of 20) versus 63 per cent (20 of 32) (P = 0·226). Acute rejection (odds ratio 4·49, 95 per cent c.i. 1·59 to 12·68; P = 0·005) and early surgical complications (OR 3·29, 1·09 to 9·99, P = 0·035) were identified as factors with an independent negative effect on graft survival. Conclusion Pancreas retransplantation may be considered for patients whose previous graft has failed. Good outcome in selected patients
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Affiliation(s)
- S Gasteiger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - B Cardini
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - G Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - F Messner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - T Resch
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - C Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - C Margreiter
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - S Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - M Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Kamran H, Kupferstein E, Sharma N, Singh G, Sowers JR, Whaley-Connell A, Yacoub M, Marmur JD, Salifu MO, McFarlane SI. Revascularization versus Medical Management of Coronary Artery Disease in Prerenal Transplant Patients: A Meta-Analysis. Cardiorenal Med 2018; 8:192-198. [PMCID: PMC6167717 DOI: 10.1159/000487763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/15/2018] [Indexed: 10/02/2023] Open
Abstract
Introduction End-stage renal disease requiring renal transplantation comprises a growing patient population at risk for cardiovascular disease (CVD) morbidity and mortality in large part due to accelerated atherosclerosis. Consequently, these patients are at even higher risk of major surgical CVD mortality. A paucity of research has addressed the posttransplantation CVD outcomes related to different treatment strategies in this patient population and therefore, there are no specific preoperative guidelines regarding management of coronary artery disease in this high-risk population undergoing renal transplantation. Objective Through meta-analysis we compare coronary revascularization to medical management prior to renal transplantation in patients who are found to have significant obstructive coronary artery disease. Results A total of 6 studies were deemed suitable out of 777 articles reviewed. This included 260 patients who received medical management and 338 who received coronary revascularization. There were 36 events in the revascularization and 57 events in the medical management group. One study only reported hazard ratios but no CVD outcomes. Comprehensive Meta-Analysis software was used to calculate pooled odds ratio with 95% confidence intervals (CI) for the fixed effects. The data is presented as forest plots. The pooled odds ratio with 95% CI for the fixed effects was 1.415 (95% CI 0.885–2.263), p = 0.147, indicating that there is no difference in CVD outcomes between pretransplant treatment strategy. This observation suggests that the CVD outcomes posttransplantation are not affected when optimal medical therapy is used instead of coronary revascularization.
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Affiliation(s)
- Haroon Kamran
- Divisions of Cardiovascular Medicine, Nephrology and Endocrinology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Eric Kupferstein
- Divisions of Cardiovascular Medicine, Nephrology and Endocrinology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Navneet Sharma
- Divisions of Cardiovascular Medicine, Nephrology and Endocrinology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Gagandeep Singh
- Divisions of Cardiovascular Medicine, Nephrology and Endocrinology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - James R. Sowers
- Divisions of Nephrology and Endocrinology, Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Adam Whaley-Connell
- Divisions of Nephrology and Endocrinology, Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Mena Yacoub
- Department of Cardiology, Northside Hospital, St. Petersburg, Florida, USA
| | - Jonathan D. Marmur
- Divisions of Cardiovascular Medicine, Nephrology and Endocrinology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Moro O. Salifu
- Divisions of Cardiovascular Medicine, Nephrology and Endocrinology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Samy I. McFarlane
- Divisions of Cardiovascular Medicine, Nephrology and Endocrinology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
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10
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Coronary Artery Disease Assessment and Intervention in Renal Transplant Patients. Transplantation 2016; 100:1580-7. [DOI: 10.1097/tp.0000000000001157] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Prognostic value of cardiac tests in potential kidney transplant recipients: a systematic review. Transplantation 2015; 99:731-45. [PMID: 25769066 DOI: 10.1097/tp.0000000000000611] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Whether abnormal myocardial perfusion scintigraphy (MPS), dobutamine stress echocardiography (DSE) or coronary angiography, performed during preoperative evaluation for potential kidney transplant recipients, predicts future cardiovascular morbidity is unclear. We assessed test performance for predicting all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACE). METHODS We searched MEDLINE and EMBASE (to February 2014), appraised studies, and calculated risk differences and relative risk ratios (RRR) with 95% confidence intervals (95% CI) using random effects meta-analysis. RESULTS Fifty-two studies (7401 participants) contributed data to the meta-analysis. Among the different tests, similar numbers of patients experienced MACE after an abnormal test result compared with a normal result (risk difference: MPS 20 per 100 patients tested [95% CI, 0.11-0.29], DSE 24 [95% CI, 0.10-0.38], and coronary angiography 20 [95% CI, 0.08-0.32; P = 0.91]). Although there was some evidence that coronary angiography was better at predicting all-cause mortality than MPS (RRR, 0.69; 95% CI, 0.49-0.96; P = 0.03) and DSE (RRR, 0.72; 95% CI, 0.50-1.02; P = 0.06), noninvasive tests were as good as coronary angiography at predicting cardiovascular mortality (RRR, MPS, 0.89; 95% CI, 0.38-2.10; P = 0.78; DSE, 1.09; 95% CI, 0.12-10.05; P = 0.93), and MACE (RRR: MPS, 1.09; 95% CI, 0.64-1.86; P = 0.74; DSE, 1.56; 95% CI, 0.71-3.45; P = 0.25). CONCLUSIONS Noninvasive tests are as good as coronary angiography at predicting future adverse cardiovascular events in advanced chronic kidney disease. However, a substantial number of people with negative test results go on to experience adverse cardiac events.
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12
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ERBP Guideline on the Management and Evaluation of the Kidney Donor and Recipient. Nephrol Dial Transplant 2014; 28 Suppl 2:ii1-71. [PMID: 24026881 DOI: 10.1093/ndt/gft218] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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13
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Wang LW, Fahim MA, Hayen A, Mitchell RL, Baines L, Lord S, Craig JC, Webster AC. Cardiac testing for coronary artery disease in potential kidney transplant recipients. Cochrane Database Syst Rev 2011; 2011:CD008691. [PMID: 22161434 PMCID: PMC7177243 DOI: 10.1002/14651858.cd008691.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at increased risk of coronary artery disease (CAD) and adverse cardiac events. Screening for CAD is therefore an important part of preoperative evaluation for kidney transplant candidates. There is significant interest in the role of non-invasive cardiac investigations and their ability to identify patients at high risk of CAD. OBJECTIVES We investigated the accuracy of non-invasive cardiac screening tests compared with coronary angiography to detect CAD in patients who are potential kidney transplant recipients. SEARCH METHODS MEDLINE and EMBASE searches (inception to November 2010) were performed to identify studies that assessed the diagnostic accuracy of non-invasive screening tests, using coronary angiography as the reference standard. We also conducted citation tracking via Web of Science and handsearched reference lists of identified primary studies and review articles. SELECTION CRITERIA We included in this review all diagnostic cross sectional, cohort and randomised studies of test accuracy that compared the results of any cardiac test with coronary angiography (the reference standard) relating to patients considered as potential candidates for kidney transplantation or kidney-pancreas transplantation at the time diagnostic tests were performed. DATA COLLECTION AND ANALYSIS We used a hierarchical modelling strategy to produce summary receiver operating characteristic (SROC) curves, and pooled estimates of sensitivity and specificity. Sensitivity analyses to determine test accuracy were performed if only studies that had full verification or applied a threshold of ≥ 70% stenosis on coronary angiography for the diagnosis of significant CAD were included. MAIN RESULTS The following screening investigations included in the meta-analysis were: dobutamine stress echocardiography (DSE) (13 studies), myocardial perfusion scintigraphy (MPS) (nine studies), echocardiography (three studies), exercise stress electrocardiography (two studies), resting electrocardiography (three studies), and one study each of electron beam computed tomography (EBCT), exercise ventriculography, carotid intimal media thickness (CIMT) and digital subtraction fluorography (DSF). Sufficient studies were present to allow hierarchical summary receiver operating characteristic (HSROC) analysis for DSE and MPS. When including all available studies, both DSE and MPS had moderate sensitivity and specificity in detecting coronary artery stenosis in patients who are kidney transplant candidates [DSE (13 studies) - pooled sensitivity 0.79 (95% CI 0.67 to 0.88), pooled specificity 0.89 (95% CI 0.81 to 0.94); MPS (nine studies) - pooled sensitivity 0.74 (95% CI 0.54 to 0.87), pooled specificity 0.70 (95% CI 0.51 to 0.84)]. When limiting to studies which defined coronary artery stenosis using a reference threshold of ≥ 70% stenosis on coronary angiography, there was little change in these pooled estimates of accuracy [DSE (9 studies) - pooled sensitivity 0.76 (95% CI 0.60 to 0.87), specificity 0.88 (95% CI 0.78 to 0.94); MPS (7 studies) - pooled sensitivity 0.67 (95% CI 0.48 to 0.82), pooled specificity 0.77 (95% CI 0.61 to 0.88)]. There was evidence that DSE had improved accuracy over MPS (P = 0.02) when all studies were included in the analysis, but this was not significant when we excluded studies which did not avoid partial verification or use a reference standard threshold of ≥70% stenosis (P = 0.09). AUTHORS' CONCLUSIONS DSE may perform better than MPS but additional studies directly comparing these cardiac screening tests are needed. Absence of significant CAD may not necessarily correlate with cardiac-event free survival following transplantation. Further research should focus on assessing the ability of functional tests to predict postoperative outcome.
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Affiliation(s)
- Louis W Wang
- St Vincent's HospitalDepartment of CardiologyDarlinghurstNSWAustralia2010
- University of SydneySydney School of Public HealthSydneyNSWAustralia
| | - Magid A Fahim
- Princess Alexandra HospitalDepartment of NephrologyBrisbaneQLDAustralia4102
| | - Andrew Hayen
- University of SydneyScreening and Test Evaluation Program (STEP), Sydney School of Public HealthA27 ‐ Edward Ford BuildingSydneyNSWAustralia2006
| | - Ruth L Mitchell
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
| | - Laura Baines
- Newcastle upon Tyne Hospitals NHSRenal ServicesFreeman RdNewcastle upon TyneUKNE7 DN
| | - Stephen Lord
- Newcastle upon Tyne Hospitals NHSCardiology ServicesNewcastle upon TyneUKNE7 7DN
| | - Jonathan C Craig
- University of SydneySydney School of Public HealthSydneyNSWAustralia
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
| | - Angela C Webster
- University of SydneySydney School of Public HealthSydneyNSWAustralia
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
- University of Sydney at WestmeadCentre for Transplant and Renal Research, Westmead Millennium InstituteWestmeadNSWAustralia2145
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Enkiri SA, Taylor AM, Keeley EC, Lipson LC, Gimple LW, Ragosta M. Coronary angiography is a better predictor of mortality than noninvasive testing in patients evaluated for renal transplantation. Catheter Cardiovasc Interv 2010; 76:795-801. [PMID: 20518007 PMCID: PMC2991378 DOI: 10.1002/ccd.22656] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The goal of this study was to compare whether coronary angiography or noninvasive imaging more accurately identifies coronary artery disease (CAD) and predicts mortality in patients with end-stage renal disease (ESRD) under evaluation for transplantation. BACKGROUND CAD is a leading cause of mortality in patients with ESRD. The optimal method for identifying CAD in ESRD patients evaluated for transplantation remains controversial with a paucity of prognostic data currently available comparing noninvasive methods to coronary angiography. METHODS The study cohort consisted of 57 patients undergoing both coronary angiography and stress perfusion imaging. Severe CAD was defined by angiography as ≥ 70% stenosis, and by noninvasive testing as ischemia in ≥ 1 zone. Follow-up for all cause mortality was 3.3 years. RESULTS On noninvasive imaging, 63% had ischemia. On angiography, 40% had at least one vessel with severe stenoses. Abnormal perfusion was observed in 56% of patients without severe disease angiographically. Noninvasive imaging had poor specificity (24%) and poor positive predictive value (43%) for identifying severe disease. Angiography but not noninvasive imaging predicted survival; 3 year survival was 50% and 73% for patients with and without severe CAD by angiography (p<0.05). CONCLUSIONS False positive scintigrams limited noninvasive imaging in patients with ESRD. Angiography was a better predictor of mortality compared with noninvasive testing.
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Affiliation(s)
- Sean A. Enkiri
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Angela M. Taylor
- Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Ellen C. Keeley
- Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Lewis C. Lipson
- Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Lawrence W. Gimple
- Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Michael Ragosta
- Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, Virginia
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Dieterle CD, Schmauss S, Arbogast H, Domsch C, Huber RM, Landgraf R. Pulmonary Function in Patients With Type 1 Diabetes Before and After Simultaneous Pancreas and Kidney Transplantation. Transplantation 2007; 83:566-9. [PMID: 17353775 DOI: 10.1097/01.tp.0000253882.95177.61] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pulmonary function is impaired in type 1 diabetes mellitus and is associated with the quality of metabolic control. Correction of chronic hyperglycemia by pancreas transplantation may ameliorate pulmonary function. METHODS Lung volume and diffusing capacity were measured in 75 uremic patients with type 1 diabetes and a long diabetes duration waiting for a simultaneous kidney and pancreas transplantation (SPK). In addition 85 patients after SPK and 20 patients after kidney transplantation alone (KA) were investigated. In a subgroup of 30 patients, data before and after SPK were available for prospective analysis. RESULTS Reduced lung volume and diffusing capacity were found in type 1 diabetic patients before transplantation. Nearly all parameters of pulmonary function improved after SPK and KA. A significant change was found for forced expiratory volume at 1 sec (FEV1) and FEV1/forced vital capacity (FVC) (Tiffenau index). A significant amelioration of diffusing capacity was only found in the SPK group but not in the KA group. The prospective investigation revealed significant improvements of pulmonary function after SPK: FEV1 (P=0.001), FVC, (P=0,006), Tiffenau index (P=0.03), and Hb-corrected diffusing capacity (carbon monoxide transfer factor, TCO), P=0.03; transfer coefficient (KCO=TCO corrected for alveolar volume), P=0.01. CONCLUSION Simultaneous pancreas and kidney transplantation is able to attain long-term normoglycemia and to improve pulmonary function in uremic type 1 diabetic patients.
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Affiliation(s)
- Christoph D Dieterle
- Department of Internal Medicine, Diabetes Center and Pulmonary Division, Medizinische Klinik Innenstadt, University of Munich, Munich, Germany.
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