Transplant Patients' Hearts Need Protecting

Editor's Choice
Main Category: Transplants / Organ Donations
Also Included In: Cardiovascular / Cardiology
Article Date: 13 Jul 2012 - 12:00 PST


In the United States, around 85,000 people are currently waiting for a kidney transplant and around 16,000 are waiting for a liver transplant. However, patients who are aged 50+ are also at increased risk of cardiovascular disease.

Now, the American Heart Association (AHA) aims to harmonize the various cardiac evaluation policies that have been created at U.S. hospitals to evaluate a patient's overall health prior to transplant surgery.

The report, co-sponsored by the American College of Cardiology Foundation, was published online ahead of print in Circulation and the Journal of the American College of Cardiology.

Krista L. Lentine, M.D., associate professor of medicine at Saint Louis University Center for Outcomes Research and Department of Medicine/Division of Nephrology, explained:

"Conducting clinically and cost-effective cardiac evaluation among patients being considered for kidney and liver transplantation is challenging due to the large size of these target populations which face high cardiac disease prevalence, the organ shortage which raises concerns for fairness and utility in transplantation, and the often extended periods between initial evaluation and transplant surgery."

Salvatore P. Costa, M.D., assistant professor of cardiology at Dartmouth-Hitchcock Medical School, and Kim A. Eagle, M.D., professor of cardiology at the University of Michigan, and colleagues analyzed data regarding cardiac assessment in kidney, and liver transplantation.

For the report the team took into consideration topics, such as:

• evidence regarding non-invasive stress testing in asymptomatic transplantation candidates
• using addition testing methods, such as cardiac biomarkers and echocardiography
• coronary revascularization and related care prior to transplantation
• medical management of cardiovascular risk factors, prior to, during, and after transplantation

Chistopher deFilipi, M.D., associate professor of medicine at the University of Maryland, explained:

"Adaptation of these guidelines will likely improve uniformity of care across centers and minimize testing of limited value. Cohesion of cardiac pre-operative risk assessment and management across centers can't be understated with many transplant candidates seeking listing at multiple centers to potentially improve their chance of transplantation.

Currently, these patients are often faced with divergent opinions and conflicting requests for pre-operative cardiac testing ranging from no testing to routine coronary angiography."

In a survey of centers taking part in the United Network for Organ Sharing, the team found that 18% of programs did not conduct routine cardiac testing for any asymptomatic patient group, and 8% ordered cardiac testing for all listed transplant candidates.

The researchers highlight that separate guidelines are required for kidney and liver transplant patients. Patients who receive kidneys are more likely to suffer from diabetes, than patients with liver failure. Cardiovascular disease is the leading cause of death among patients with end-stage renal failure, while patients awaiting living transplantation suffer from problems, such as pulmonary hypertension.

Before patients undergo transplantation, coronary revascularizing procedures, including angioplasty, should be taken into consideration based on patients symptoms, ischemic burden and cardiac function.

Costa, a cardiologist at Dartmouth-Hitchcock, explained: "However, we also recognize that in some asymptomatic transplantation candidates, the risk of coronary revascularization may outweigh the risk of transplantation, and these risks must be weight by the multidisciplinary transplantation team on a case-by-case basis until further studies are performed in this population."

According to the researchers, hospital should select a primary cardiology consultant for questions associated to potential transplant candidates.

Eagle, a director of the University of Michigan Cardiovascular Center, concluded: "Overall, we hope this statement will offer a foundation for centers to coordinate and better standardize cardiac evaluation practices before kidney and liver transplantation according to best available sources.

We hope the document will provide an impetus to advancing the evidence basis for cardiac evaluation and management specifically in the population with end-stage organ failure being considered for transplantation, so that in the end we can reduce cardiac morbidity and mortality in this population and facilitate safe transplant surgery without incurring risks and expense from unnecessary testing."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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