Journal List > J Korean Soc Transplant > v.25(4) > 1034347

J Korean Soc Transplant. 2011 Dec;25(4):225-228. Korean.
Published online December 31, 2011.
Copyright © 2011 The Korean Society for Transplantation
Cardiovascular Screening before Transplantation
Yong-Lim Kim, M.D.
Clinical Research Center for ESRD and Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

Corresponding author (Email: )
Received November 19, 2011; Accepted November 21, 2011.


Because of the high prevalence of clinically silent cardiovascular disease and increased incidence of adverse cardiovascular events in transplant recipients, cardiovascular evaluation before transplantation is critical. The standard non-invasive screening tests for evaluating coronary artery disease include dobutamine stress echocardiogram and myocardial perfusion image (adenosine, dipyridamole nuclear scintigraphy). The optimal non-invasive screening test is unclear, with the optimal choice based upon the expertise of the particular medical center. The practitioner is advised to view current guidelines as recommendations rather than as strict rules and to combine them with clinical judgments. In addition, excessive reliance on noninvasive tests that are not sufficiently accurate to exclude significant coronary artery disease in high-risk candidates may engender a false sense of security.

Keywords: Transplantation; Mass screening; Cardiovascular diseases


Fig. 1
Algorithm for cardiac assessment of high risk patients on the waiting list for kidney transplantation.
Click for larger image

Fig. 2
Plain lumbar spine X-ray showing vascular calcification (white arrow).
Click for larger image


Table 1
High risk patients needed for more intense monitoring for coronary artery disease
Click for larger image

Table 2
Cardiac testing modalities for the presence of coronary artery disease: sensitivity, specificity, predictive value
Click for larger image

Table 3
Recommendations for cardiac surveillance of kidney transplantation waitlisted patients
Click for larger image

1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–1305.
2. Ojo AO. Cardiovascular complications after renal transplantation and their prevention. Transplantation 2006;82:603–611.
3. Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Ishani A, et al. United States Renal Data System 2008 Annual Data Report. Am J Kidney Dis 2009;53 1 Suppl:S1–S374.
4. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725–1730.
5. Tiukinhoy-Laing SD, Rossi JS, Bayram M, De Luca L, Gafoor S, Blei A, et al. Cardiac hemodynamic and coronary angiographic characteristics of patients being evaluated for liver transplantation. Am J Cardiol 2006;98:178–181.
6. Targher G, Arcaro G. Non-alcoholic fatty liver disease and increased risk of cardiovascular disease. Atherosclerosis 2007;191:235–240.
7. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 2007;116:1971–1996.
8. Kasiske BL, Cangro CB, Hariharan S, Hricik DE, Kerman RH, Roth D, et al. The evaluation of renal transplantation candidates: clinical practice guidelines. Am J Transplant 2001;1 Suppl 2:3–95.
9. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005;45 4 Suppl 3:S1–S153.
10. Gaston RS, Danovitch GM, Adams PL, Wynn JJ, Merion RM, Deierhoi MH, et al. The report of a national conference on the wait list for kidney transplantation. Am J Transplant 2003;3:775–785.
11. Herzog CA, Marwick TH, Pheley AM, White CW, Rao VK, Dick CD. Dobutamine stress echocardiography for the detection of significant coronary artery disease in renal transplant candidates. Am J Kidney Dis 1999;33:1080–1090.
12. Delos Santos RB, Gmurczyk A, Obhrai JS, Watnick SG. Cardiac evaluation prior to kidney transplantation. Semin Dial 2010;23:324–329.
13. Rabbat CG, Treleaven DJ, Russell JD, Ludwin D, Cook DJ. Prognostic value of myocardial perfusion studies in patients with end-stage renal disease assessed for kidney or kidney-pancreas transplantation: a meta-analysis. J Am Soc Nephrol 2003;14:431–439.
14. Tsutsui JM, Mukherjee S, Elhendy A, Xie F, Lyden ER, O'Leary E, et al. Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease. Liver Transpl 2006;12:592–599.
15. EBPG (European Expert Group on Renal Transplantation); European Renal Association (ERA-EDTA); European Society for Organ Transplantation (ESOT). European Best Practice Guidelines for Renal Transplantation (part 1). Nephrol Dial Transplant 2000;15 Suppl 7:1–85.
16. De Lima JJ, Sabbaga E, Vieira ML, de Paula FJ, Ianhez LE, Krieger EM, et al. Coronary angiography is the best predictor of events in renal transplant candidates compared with noninvasive testing. Hypertension 2003;42:263–268.
17. Kim CD, Lee HJ, Kim DJ, Kim BS, Shin SK, Do JY, et al. High prevalence of leukoaraiosis in cerebral magnetic resonance images of patients on peritoneal dialysis. Am J Kidney Dis 2007;50:98–107.
18. Barbagallo CM, Pinto A, Gallo S, Parrinello G, Caputo F, Sparacino V, et al. Carotid atherosclerosis in renal transplant recipients: relationships with cardiovascular risk factors and plasma lipoproteins. Transplantation 1999;67:366–371.
19. Knoll G, Cockfield S, Blydt-Hansen T, Baran D, Kiberd B, Landsberg D, et al. Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation. CMAJ 2005;173:1181–1184.