Hennepin County Medical Center, Minneapolis, Minnesota, USA.
Curr Opin Nephrol Hypertens. 2010 Nov;19(6):586-91. doi: 10.1097/MNH.0b013e32833e034e.
Cardiovascular disease is the leading cause of death in kidney transplant recipients. Hence, accurate cardiac risk assessment in potential candidates is an important issue. The purpose of this review is to examine the existing research on the screening and management of pretransplant cardiovascular disease, with an emphasis on defining the optimal approach for asymptomatic high-risk candidates.
Randomized controlled trials (RCTs) in the general population demonstrate that prophylactic revascularization in stable patients prior to major noncardiac surgery does not reduce cardiac events or improve survival postoperatively. The benefit of noninvasive stress testing in this population is doubtful based on smaller RCTs and observational studies. Perioperative beta-blockade in intermediate-risk or high-risk candidates appears to be beneficial but acute administration is harmful.
Investigation for coronary artery disease is warranted for kidney transplant candidates with symptoms of myocardial ischemia. However, there is insufficient evidence to support routine cardiovascular screening in asymptomatic candidates regardless of their cardiac risk factor status. RCTs specifically looking at this issue in renal transplant candidates are a research priority.
心血管疾病是肾移植受者的主要死亡原因。因此，准确评估潜在受者的心脏风险是一个重要问题。本文的目的是探讨移植前心血管疾病的筛查和管理的现有研究，重点是确定无症状高危受者的最佳方法。
在一般人群中的随机对照试验（RCT）表明，在主要非心脏手术前稳定患者中进行预防性血运重建并不能减少心脏事件或改善术后生存。基于较小的 RCT 和观察性研究，对该人群进行非侵入性应激测试的益处值得怀疑。围手术期使用β受体阻滞剂在中危或高危受者中似乎有益，但急性给药则有害。
有心肌缺血症状的肾移植受者需要进行冠状动脉疾病检查。然而，无论其心脏危险因素状况如何，均无足够证据支持对无症状受者进行常规心血管筛查。专门针对肾移植受者的 RCT 对此问题进行研究是当务之急。
