Screening and management of pretransplant cardiovascular disease

Purpose of review: 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. Recent findings: 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. Summary: 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.