Adult Transplant Nephrology, Department of Organ Transplant Center, King Abdulaziz Medical City; King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Department of Transplant Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Saudi J Kidney Dis Transpl. 2020 May-Jun;31(3):655-675. doi: 10.4103/1319-2442.289452.
Screening for cardiovascular (CV) disease before transplant is common. However, the clinical utility of screening asymptomatic transplant candidates remains unclear. There is a large degree of variation among the practices of the different transplant centers in the Kingdom of Saudi Arabia (KSA) and among the international guidelines. Opinions are mostly based on mixed observational data with a great potential for bias. When compared to the Western countries, renal-transplant candidates in the KSA are likely to have longer dialysis vintage, higher prevalence of catheter use, higher rate of uncontrolled hyperparathyroidism, and high prevalence of diabetes. These factors are likely to expose renal-transplant candidates to a higher CV risk than those in Western countries. In the absence of any published guideline for CV risk assessment of the renal-transplant candidate in the KSA, we present these guidelines as the first published guidelines in the KSA. These guidelines review the pertinent aspects from the most recent American College of Cardiology/American Heart Association guidelines for cardiac disease evaluation and management among kidney-transplant candidates and reflect on the local practices in the KSA. These guidelines overview many of the daily- encountered challenges in renal transplantation such as the indications for stress testing, screening coronary angiogram and prophylactic revascularization, screening and management of pulmonary hypertension, cardiac surveillance while on the waiting list and duration of dual-antiplatelet therapy before renal transplant. These guidelines were reviewed by a team of consultant nephrologists, cardiologists, anesthesiologists, and transplant surgeons from six major transplant centers in the KSA. The guidelines aim to standardize the practices of CV risk assessment in kidney transplantation in the KSA, according to the most up-to-date available evidence. The expected impact of these guidelines on the current practices is also reviewed here.
在移植前对心血管疾病进行筛查很常见。然而，对无症状移植候选者进行筛查的临床效用尚不清楚。沙特阿拉伯王国（KSA）不同移植中心之间以及国际指南之间的实践存在很大差异。意见主要基于混合观察性数据，存在很大的偏倚风险。与西方国家相比，KSA 的肾移植候选者可能有更长的透析史、更高的导管使用率、更高的未控制甲状旁腺功能亢进发生率和更高的糖尿病患病率。这些因素可能使肾移植候选者面临比西方国家更高的心血管风险。由于目前沙特阿拉伯没有发表针对肾移植候选者心血管风险评估的指南，因此我们在此提出这些指南，这是沙特阿拉伯发表的第一批指南。这些指南审查了最近美国心脏病学会/美国心脏协会指南中有关肾移植候选者心脏病评估和管理的相关方面，并反映了沙特阿拉伯的当地实践。这些指南概述了肾移植中遇到的许多日常挑战，例如应激试验的适应证、筛查冠状动脉造影和预防性血运重建、肺动脉高压的筛查和管理、在等待名单期间的心脏监测以及肾移植前双联抗血小板治疗的持续时间。这些指南由来自沙特阿拉伯六个主要移植中心的顾问肾病学家、心脏病专家、麻醉师和移植外科医生组成的团队进行了审查。这些指南旨在根据最新的现有证据，使沙特阿拉伯的肾移植中心血管风险评估实践标准化。还在此审查了这些指南对当前实践的预期影响。
