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Cardiovascular Risk Assessment in Renal and Liver Transplant Candidates

A Multidisciplinary Institutional Standardized Approach

Mohebali, Donya MD*; Anagnostopoulos, Anne-Marie MD*; Estrada-Roman, Alisson MD*; Pavlakis, Martha MD; Curry, Michael P. MD; Gavin, Michael C. MD, MPH*

doi: 10.1097/CRD.0000000000000282
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In the modern era, renal and liver transplant candidates present with a greater medical complexity driven in part by a higher prevalence of cardiovascular conditions, including coronary artery disease, valvular heart disease, and cardiomyopathies. In fact, cardiovascular disease is the most common cause of death after kidney transplantation worldwide. Similarly, an increase in the number of patients being listed with end-stage liver disease from nonalcoholic steatohepatitis and a rising model for end-stage liver disease scores at the time of liver transplant in the United States parallel an increasing cardiovascular disease risk profile for liver transplant candidates. A large degree of variation exists among clinical practice guidelines and transplant center practice patterns regarding patient selection for routine cardiac testing and the choice of testing modalities. Here, we review the clinical practice guidelines established at our center by a multidisciplinary group, including transplant nephrology, hepatology, and surgery, as well as general and interventional cardiology, with the goal of improving patient selection and reducing adverse cardiac events posttransplant.

From the *Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA

Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Michael C. Gavin, MD, MPH, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 217, Boston, MA 02215. E-mail: mgavin2@bidmc.harvard.edu.

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