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Myocardial ischemia by radionuclide imaging and long-term outcomes after kidney transplantation.

Abstract：

PURPOSE:We examined the incidence of myocardial ischemia (MI) in kidney transplant recipients (KTR) using myocardial perfusion imaging (MPI), and its association with long-term outcomes after transplantation. METHODS:A retrospective observational study was conducted of asymptomatic KTRs who underwent post-transplant MPI screening for MI, as defined by moderate to severe myocardial perfusion defects, post-stress myocardial stunning or balanced ischemia. A composite outcome of all-cause mortality, graft loss, and major adverse cardiovascular events (MACE) was examined over minimum 5 years. RESULTS:We studied 135 KTRs who underwent 226 MPIs, with follow-up duration of 10 (7-13) years. 110 (81%) patients had normal MPIs, 11 (8%) had mild perfusion defects, and 14 (10%) had MI. Correspondingly, composite outcome developed in 6%, 27%, and 43% (p = 0.04), and MACE occurred in 7%, 0%, and 21% (p = 0.11), of the respective subgroups. Twenty-six patients developed the composite outcome after 5 (3-7) years post-transplantation, including 11 patients with MACE. On multivariate analysis, MI, higher low-density lipoprotein levels, and proteinuria > 0.3 g/day independently predicted the composite outcome; only MI predicted MACE (all p < 0.05). Ninety-one patients had two serial MPIs, which increased the positive predictive value for MACE from 17 to 25%. Absence of MI had negative predictive value of 83% for MACE and 93% for the composite outcome. CONCLUSION:MI that is detected early post-kidney transplantation predicts long-term mortality, graft loss, and MACE in KTRs, with excellent negative but poor positive predictive values.

journal_name

Int Urol Nephrol

journal_title

International urology and nephrology

authors

Low S,Chua HR,Wong R,Goh A,Ng YH,Teo BW,Vathsala A

doi

10.1007/s11255-020-02542-7

subject

Has Abstract

pub_date

2020-10-01 00:00:00

pages

1995-2003

issue

10

eissn

0301-1623

issn

1573-2584

pii

10.1007/s11255-020-02542-7

journal_volume

52

pub_type

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