Purpose: Cardiac events are now the leading cause of early mortality after kidney transplantation. Long term exposure to immunosuppression also increases cardiometabolic stress after transplantation. Several studies in general population have shown that the presence of coronary artery calcification increases the risk of future cardiovascular events. Among pre-kidney transplant candidates, there remains wide variation in cardiac risk assessment practices across transplant centers. We report coronary angiography findings in asymptomatic candidates undergoing Kidney transplant evaluation with negative stress test but with findings of coronary or aorto-iliac calcification on CT imaging.

Methods: We conducted a retrospective single center study of 76 Pre-Kidney transplant recipients who had a negative stress test and underwent coronary angiography between 2010 to 2021. All patients underwent coronary angiography based on coronary or aortoiliac calcification on CT imaging. Mean age was 60 years in both groups. Demographics and results are listed in table 1.

Results: Results at our academic center showed that 18 out of 76 patients (23.6%) had a 70% stenosis in one or more coronary vessels. 11 out of 76 patients (14.4%) underwent single or multiple vessels stent placement and one underwent CABG. 7 out of 76 patients (9%) had significant distal disease or vessels were too small for intervention. In CAD group, 13 out of 18 patients (72%) were diabetic. All patients underwent successful kidney transplantation. Post Operative hypotension was more common in non-CAD group, in 9 patients as compared to 3 patients in CAD group. 5 patients in non-CAD recipients had post-op Atrial fibrillation Vs 1 in CAD group.

Conclusions: In addition to traditional risk factors and other cardiac risk stratification modalities, Coronary or aorto-iliac calcification on CT imaging is a predictor of significant coronary artery disease in patients undergoing evaluation for kidney transplant surgery. coronary angiography before transplantation should be considered  for potential candidates for Kidney transplant with negative stress test but significant vascular calcification.