Rajnochova Bloudickova Silvie, Janek Bronislav, Machackova Karolina, Hruba Petra
Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Front Cardiovasc Med. 2024 Jan 24;11:1322176. doi: 10.3389/fcvm.2024.1322176. eCollection 2024.
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in kidney transplant recipient (KTR). There is a dearth of standardized guidelines on optimal cardiovascular evaluation of transplant candidates.
This single-center cohort study aims to determine the effectiveness of our standardized risk-stratified pretransplant cardiovascular screening protocol, which includes coronary angiography (CAG), in identifying advanced CVD, the proper pretransplant management of which could lead to a reduction in the incidence of major cardiac events (MACE) in the early posttransplant period.
Out of the total 776 KTR transplanted between 2017 and 2019, CAG was performed on 541 patients (69.7%), of whom 22.4% were found to have obstructive coronary artery disease (CAD). Asymptomatic obstructive CAD was observed in 70.2% of cases. In 73.6% of cases, CAG findings resulted in myocardial revascularization. MACE occurred in 5.6% ( = 44) of the 23 KTR with pretransplant CVD and 21 without pretransplant CVD. KTR with posttransplant MACE occurrence had significantly worse kidney graft function at the first year posttransplant ( = 0.00048) and worse patient survival rates ( = 0.0063) during the 3-year follow-up period compared with KTR without MACE. After adjustment, the independent significant factors for MACE were arrhythmia (HR 2.511, = 0.02, 95% CI 1.158-5.444), pretransplant history of acute myocardial infarction (HR 0.201, = 0.046, 95% CI 0.042-0.970), and pretransplant myocardial revascularization (HR 0.225, = 0.045, 95% CI 0.052-0.939).
Asymptomatic CVD is largely prevalent in KTR. Posttransplant MACE has a negative effect on grafts and patient outcomes. Further research is needed to assess the benefits of pretransplant myocardial revascularization in asymptomatic kidney transplant candidates.
心血管疾病（CVD）是肾移植受者（KTR）发病和死亡的主要原因。目前缺乏关于移植候选者最佳心血管评估的标准化指南。
这项单中心队列研究旨在确定我们标准化的风险分层移植前心血管筛查方案（包括冠状动脉造影（CAG））在识别晚期CVD方面的有效性，对其进行适当的移植前管理可降低移植后早期主要心脏事件（MACE）的发生率。
在2017年至2019年间移植的776例KTR中，541例患者（69.7%）接受了CAG检查，其中22.4%被发现患有阻塞性冠状动脉疾病（CAD）。70.2%的病例观察到无症状性阻塞性CAD。73.6%的病例中，CAG检查结果导致心肌血运重建。23例移植前患有CVD的KTR和21例移植前未患有CVD的KTR中，MACE发生率为5.6%（n = 44）。与未发生MACE的KTR相比，发生移植后MACE的KTR在移植后第一年的肾移植功能明显更差（P = 0.00048），在3年随访期内的患者生存率也更差（P = 0.0063）。调整后，MACE的独立显著因素为心律失常（HR 2.511，P = 0.02，95% CI 1.158 - 5.444）、移植前急性心肌梗死病史（HR 0.201，P = 0.046，95% CI 0.042 - 0.970）和移植前心肌血运重建（HR 0.225，P = 0.045，95% CI 0.052 - 0.939）。
无症状性CVD在KTR中普遍存在。移植后MACE对移植肾和患者预后有负面影响。需要进一步研究评估移植前心肌血运重建对无症状肾移植候选者的益处。
