Low Incidence of Cardiac Death After Renal Transplantation in Patients Undergoing Pre-Emptive Coronary Angiography and Revascularisation.

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Purpose Cardiovascular disease is one of the commonest and potentially treatable causes of death with a functioning renal allograft. All our high-risk patients, including those >50 years of age are offered pre transplant coronary angiography and revascularisation, if flow-limiting disease is identified and in this study we analyse their outcomes. Methods. 572 transplant patients [m:f 368:204, mean age 56.7 ± 9.4 yrs, range 25 - 78] who underwent coronary angiography prior to renal transplantation were included. Results 133/572 [23.3%] had normal coronary angiograms, 296/572 [51.7%] had mild to moderate disease, 98/572 [17.1%] underwent intervention for significant disease [73 PCI, 25 CABG] and 45/572 [7.9%] with significant disease were managed medically. The mean follow up post-transplant was 52 ± 28 months. Only 9/572 [1.57%] of these patients died from cardiac causes. 87 other cardiac events occurred. 37/572 [6.5%] patients had Non ST Elevation Myocardial Infarctions (NSTEMI), 12/572 [2.1%] STEMIs and 38/572 [6.6%] had arrhythmias. Cardiac event-free survival at 1, 3 and 5 years was 94%, 90.4% and 87.8% for patients with normal coronary angiograms, 93.6%, 91.7% and 86.9% for patients with mild to moderate findings, 86.7%, 86.7%, 69% for patients with significant findings and 80.6%, 73.1%, 65.5% for patients who underwent intervention. Cox-regression analysis showed that the presence of coronary artery disease requiring intervention increased the risk of subsequent cardiac events [Exp(B)=2.735, p=0.002]. History of pre-transplant diabetes [Exp(B)=2.665, p=0.001] increased the risk for death. Conclusion This study shows that patients managed in this way have a very low incidence of cardiac death after transplantation. Patients with normal or mild coronary disease have a very low incidence of subsequent cardiac events. However, patients with significant disease, despite intervention, continue to have cardiac events post-transplant and this group of patients merit additional study and focus to reduce the burden of post-transplant cardiac disease even further.

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